Membership Form

Membership Form

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Membership or Renewal Form

Check if this is a membership Renewal ______ 

 

To join or renew by mail, please print and complete this form and mail with your check to: 
     LWVBCC
     P.O. Box 1032

     Niles, MI 49120

 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  ________________________________

 Select your Annual Membership dues from the following and enclose your check payable
 to LWVBCC:
      _______  $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.

 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

Thank you for your support of the League 

PDF icon Printable Membership Form (pdf)