Bohemia Civic Association

Print this page, fill it out, and return it with your payment. Prints on one sheet.

Bohemia Civic Association logo

Est. 1986 · Bohemia, New York

Bohemia Civic Association

Serving Bohemia & Connetquot residents in the Town of Islip

Membership
Application Annual · 2026

Membership is open to all Bohemia and Connetquot residents and to local businesses serving our community. Complete this form and return it with your payment — details at the bottom of the page. Questions? Email bohemiacivicassoc@gmail.com.

1 Membership Type check one

Resident Membership

For residents of Bohemia & Connetquot. Meeting notices, community updates, and a voice in our advocacy.

Individual $20
Family $25
Senior (65+) $15

Business Membership $50

Featured listing with a link on our website, shoutouts on Facebook, and a direct connection to hundreds of local residents.

New member
Renewing member
Please add me to the email list

2 Member Information

Section 3 · Business members only — how you'll appear in our listing

4 I'd Like to Help With optional — check any that interest you

Community events
Advocacy & land use
Newsletter & social media
Attending Town hearings
Beautification & cleanups
Membership outreach
Fundraising
Serving on the board
Wherever I'm needed

5 Dues & Payment

Check enclosed
Cash enclosed

Make checks payable to Bohemia Civic Association. Please do not mail cash — bring cash payments to a meeting in person. Dues cover the membership year and are not tax‑deductible as a charitable contribution.

Membership dues$
Additional donation$
Total enclosed$

6 Signature

Signature
Date

Return by mail

Bohemia Civic Association
819 Bohemia Parkway
Bohemia, NY 11716

Or bring it in person

Hand this form and your payment to any board member at a monthly meeting. Meeting dates are posted at bohemiacivic.org and on our Facebook page.

bohemiacivic.org · bohemiacivicassoc@gmail.com · facebook.com/BohemiaCivicAssoc Office use: Rec'd _______ · Amt _______ · Ck# _______ · Entered _______