Common Interest Community Association

NEW PIASA CHAUTAUQUA – COMMON INTEREST COMMUNITY ASSOCIATION Application for Rental (To be accompanied with a $25.00 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 and family members who will be present: 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 Chautauqua that you have had (i.e., visiting, renting, childhood, etc.).

Your Chautauqua References: List any current members of New Piasa Chautauqua who could be contacted for character references.

of 2 Revised September 2015 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

Applicant and family understand that renters at Chautauqua are expected to participate and to support the summer season program events and to become actively involved? Yes No

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:

New Piasa Chautauqua has no obligation to confer the privilege of rental to an applicant not acceptable to the Board or the community. The Board reserves the right to refuse rental 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 rental is for a three-year period. It is the obligation of the applicant to arrange for periodic re-approvals.

The application should be submitted to the Chairman of the NPC-CICA Membership Committee.