New Piasa Chautauqua-

COMMON INTEREST COMMUNITY ASSOCIATION

Application for Membership

(To be accompanied with a $50.00 check payable to NPC-CICA)

Date:
Mission Statement
The Board of Directors’ mission is to fairly, safely, equitably and economically administer the assets, employees and programs of New Piasa Chautauqua – Common Interest Community Association (NPC-CICA) with no regard to race, religion, sex or age, but to do so in a manner that respects the history of NPC-CICA yet to plan for the continuation of NPC-CICA into the future for many generations to come. The overriding goal of NPC-CICA activities is to promote the Religious, Educational and Scientific objectives of NPC-CICA and operate in connection therewith a summer resort.
Applicant(s) who will be considered for membership and family members who will be present:
Name / Age / Relationship to Applicant(s)
Names of family members (not listed above) who will or may occupy the leasehold:
Name / Age / Relationship to Applicant(s)
Home Address:
Own Rent How long?
Home Phone #: / Work Phone #:
Cell Phone #: / E-Mail Address:
Applicant’s Employer: / Position:
Address: / How long?
Co-Applicant’s Employer: / Position:
Address: / How long?
Your Chautauqua Connections:
Describe any past association with New Piasa Chautauqua that you have had (i.e., visiting, renting, childhood, etc.).
Volunteer Activities:
Our community is operated by and depends on its volunteers. Please list several of your volunteer activities.
Will you and your family participate in and support our seasonal programs and events? Yes No
Personal Commitment:
Applicant and family have read and are familiar with the applicable sections of our By-Laws and Rules and Regulations and agree to abide by them? Yes No
As mentioned in our mission statement, Chautauqua has a religious component that is important to the community. Will you support the Church Assembly with both your attendance and financial contributions? Yes No
Applicant and family understand that leaseholders at Chautauqua are expected to participate and to support the summer season program events and to become actively involved? Yes No
Applicants, if approved for membership and subsequently become leaseholders, intend to spend the following amount of time at Chautauqua during the summer seasons: (Please check all that apply.)
10-12 weeks during the summer season / vacation time; for / weeks vacation
6-10 weeks during the summer season / off-season months (September-May)
less than 6 weeks during the summer season / year-round residency (Note that additional application must
weekends only; most weekends / be made and approved before year-round residency status
weekends only; occasionally / may be obtained)

Complete this section ONLY if you anticipate spending less than 10-12 weeks at Chautauqua during the annual summer season:

We would rent our cottage to other approved individuals during the weeks we are not able to be at Chautuauqua. (Please note: A cleaning service can be made available.)

We would NOT consider renting out our cottage.

The signature(s) noted below affirm that all the information provided on this application for New Piasa Chautauqua are correct and true.
Applicant’s Signature: / Printed: / Date:
Co-Applicant’s Signature: / Printed: / Date:
Co-Applicant’s Signature: / Printed: / Date:
Co-Applicant’s Signature: / Printed: / Date:
A background check will be run on all applicants.
New Piasa Chautauqua has no obligation to confer the privilege of membership to an applicant not deemed acceptable to the Board or the community.
The Board reserves the right to refuse membership status without providing specific reasons.
The Board reserves the right to rescind or revoke approvals when it becomes apparent that such approval is not in the best interest of the community.*
Approval for membership is for a three-year period. It is the obligation of the applicant to arrange for periodic re-approvals. Once membership is confirmed and a lease is executed, no renewal is required.
* This includes violation of the terms of the lease and/or violation of our by-laws and rules and regulations.
The completed application should be submitted to the Chairman of the New Piasa Chautauqua Membership Committee.

Page 1 of 3Revised May 2014