Check the type of annual membership of your choice:

_________,$55.00: Individual Membership

_________,$75.00: Household Membership (2 members at the same address)

I'm unable to join the League at this time, however enclosed is a contribution of

$______ to Lake Charles League of Women Voters (not tax deductible)

$______ to LWV, LA (State) Education Fund (tax deductible)

_______ Please contact me or my company about sponsoring an upcoming event.

Name(s)___________________________________________Company_________________________________

Address __________________________________________City _____________________________________

Parish _____________________________State __________ Zip _________________

Phone No. (Home): ______________________,Work: ___________________, Mobile:___________________

Fax: _____________________, e-mail address:__________________________________________________

Voting Precint:_____________________

Issues I am most interested in: Education ______, Health Care ______, Environment_____, Crime_____, Other: ______________________

________ I want to be an ACTIVE participant in the League of Women Voters.

I would like to participate in the following: Candidate Forums______, Board Position______, Special Committee______

Skills and/or time I can contribute:____________________________________________________________