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League of Women Voters of Northeast Tennessee

MEMBERSHIP APPLICATION

Primary Member Name ____________________________________Date of Birth ___/___/____

Household Member Name (if Applicable) __________________________ Date of Birth ___/___/____

Address  ________________________________________________

City ______________________________ State _TN_ Zip 37________

E-mail(s): _____________________________________________________________

Home phone 423-_____________ Cell  ______________ Work ____________Fax___________

2007 - 2008 dues:

[] Individual Member @ $50.00 [] Additional member in the same household or students @ $25.00

[] Contribution to Education Fund (Separate check) _________   [] Contribution to General Fund  _________   

Payable to: LWV TN EF                                                                Payable to:  LWV NE TN

Mail to:        Alan Karp, Treasurer
                                    3401 Sugartree Court