Buffalo Community Association Registration Form

Please fill out form to receive access to Third Estate's Property Database for the area you represent.

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* 1. Entity Name

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* 2. Check Applicable Box

Starting New Community Group

Existing Unregistered Community Group

Existing Registered Community Group

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* 3. If registered with Board of Block Clubs, what was your registration date.

Date / Time

Date

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* 4. Date Established

Date / Time

Date

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* 5. Entity Contact Information

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 6. Area of Operation (i.e. Boundaries)

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* 7. Meeting Information

Day

Place

Time

Other

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* 8. Number of Members

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* 9. Council District

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* 10. Police District

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* 11. Officer Contact (President)

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address

Phone Number *

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* 12. Officer Contact (Secretary)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 13. Check Box for Third Estate to serve as Treasurer

Yes, we would like to apply for coverage under a Group Exemption Letter held by Third Estate Ventures, Inc. [a 501(c)(3)], so that we may immediately be considered a public charity.

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* 14. Officer Contact (Treasurer)

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 15. Names of Initial Board Members

President

Vice President

Secretary

Treasurer

Other