League of Women Voters of Rensselaer County Membership
July 1, 2010 - June 30, 2011
Please copy and mail, along with your check, to:
Nancy Fairchild, 16 Pineview Lane, E. Greenbush, NY, 12061
| Name:
|
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*Household Member Name (if applicable):
|
| Mailing Address:
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| Phone & Email Address
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| Location of your Polling Place :
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| Dues (Please check appropriate category) : |
| $50 ___ Individual Member |
| $75 ___ * Household Membership (second member at same address) |
| $75 ___ # Sustaining Individual Member |
| $100 ___ # Sustaining Household Membership |
| $_______ Additional Contribution |
| $ _________ Total |
|
Optional Comments/Direction to Board:
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Please make check payable to: LWV of Rensselaer County
Mail your check and this form to: Irene Wynnyczuk, LWV
Treasurer, 404 McChesney Ave. Ext., Apt. 26-6, Troy, NY 12180
#Sustaining Memberships provide a contribution to the LWV above regular dues.