Membership Form
Print this page and send along with your check to the address at the bottom.
Yes, I want to be a part of the League of Women Voters of Dane County, Inc.
Name: ___________________________________________
Address: _________________________________________
City: _________________________ State: __ Zip: _________
Phone: ____________________ Year Joined LWV: _________
E-Mail: ___________________________________________
Membership: [Check your selection]
If you haven't already renewed your membership, OR if you have a friend who would like to join, take advantage of the Special Half-Year Dues Rate for the remaining fiscal year, January 1, 2006 – June 30, 2006!
| Member | ______ $35 |
| Second Member [same address, shares mailings with first member] | ______ $30 |
| Special Rate Member [of limited income or a student] | ______ $17.50 |
| Member Contribution: [Check your selection] | ______ $1,000 - 500 |
| ______ $499 - 200 | |
| ______ $199 - 100 | |
| ______ $99 - 50 | |
| ______ other | |
______ Total |
Please make check payable to:
The League of Women Voters of Dane County, Inc.
2712 Marshall Court, Suite 2, Madison, WI 53705-2282