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