TOWN OF WAKE FOREST
HISTORIC PRESERVATION COMMISSION
MEMBERSHIP APPLICATION FORM
Applicant Name: ________________________________________ Date: _______________
Address: _____________________________________________________________________
Home Phone: _____________________ Business/Other Phone: ______________________
Email Address: _________________________________________________________________
Do you live in or own property in a Wake Forest historic district? (Check as appropriate)
Live in: ______ Own: _______ Both: _______
Which historic district? (Check all appropriate)
______Local District (North Main Street, North Avenue, and South Avenue)
______Wake Forest National Register District
______Glen Royall Mill Village District
______Downtown Wake Forest District
Occupation: __________________________________________________________________
Please list personal, professional, and organization activities related to historic preservation. These
may include restoring or rehabilitating an older house or place of business; involvement in
community preservation organizations, historical societies, or other groups working to promote
historic preservation; involvement in historic preservation as a professional architect, historian,
architectural historian, archaeologist, landscape architect, planner, anthropologist, curator,
conservationist, or folklorist; or other activities that are related to historic preservation (attach extra
sheet, if necessary). (Information required by State Historic Preservation Office.)
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Revised 10-7-10
