Membership Form

Membership Form

LWVBCC Membership Form

Name__________________________________________________________________
If this will be a household membership, please provide name of other household member. _______________________________________________________________________

Address_________________________________________________________________

City_______________________________ Zip Code _____________________________

Phone (home)________________________ Phone (work/day)_____________________

Cell phone_______________ Email address____________________________________

Amount enclosed $______________________ $70.00 individual member. $95.00 two members same household. No fee for students: just submit the completed form.

Please write your check to: LWVBCC . You may mail the check and this form to LWVBCC at P.O. Box 1032, Niles, MI 49120.

If you prefer, you can pay via PayPal by going to our website: www.lwvbcc.org.

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

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