Membership Form

Membership Form

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Membership Form

1) Print this form - (Printable Membership Form (pdf))

    New Applicants complete all information - Renewal Applicants update information that has changed

Check if this is a membership Renewal ______ 

 

Name  ________________________________________________________________________

Address  ______________________________________________________________________

City  ________________________________________________  Zip Code  ________________

Phone (home)  ___________________________  Phone (Cell)  __________________________ 

Email address _________________________________________________________________

Name for 2nd household member, if applicable  _______________________________________

Cell phone for 2nd household member, if applicable  ___________________________________ 

Email address for 2nd household member, if applicable  ________________________________

Please give us specifics about your interests (circle all that apply):

Voter Services, Energy/Environment, Health & Social Services, Public Education, Budget/Finance,

Membership, Nominating, Special Events & Programs, Other  

Comments (e.g. interests, how you heard about the League):

 
2) Write your check payable to LWVBCC - select your annual membership dues from the list below:
      _______  $70.00 for an individual membership
      _______  $95.00 for two members in the same household
      _______  No fee for students: just submit the completed membership form.

      (dues paid online are slighly higher - see Join or Renew on our website: www.lwvbcc.org.

 3) Mail completed Membership Form and your annual dues check to: 

             LWVBCC
             P.O. Box 1032

             Niles, MI 49120

Thank you for your support of the League