a
renewal
a new membershipLST 1148 DUES
Name_________________________________________________________
Spouse’s Name_________________________________________________
Address_______________________________________________________
City _______________________________State________ Zip___________
Home phone ________________________Work Phone________________
Fax ______________________e-mail_______________________________
Check here if this is :
a
renewal
a new membership
check for $10 enclosed (1
year)
check for $20 enclosed (2 years)
Make out your check to
George Stankus
Send it with this
form to him at 4519 Drake Drive