Leading the Way for Voters! Membership Form

League of Women Voters of Lackawanna County
PO Box 43
Scranton, PA 18501

Name: ____________________________________________________

Mailing Address: ____________________________________________

_____________________________________________

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 Day Phone Number: _________________Evening Phone Number: _______________

E-mail address: __________________________________________

Best day for evening meetings: __________ morning meetings ____________

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Type of Membership (must be a US citizen, at least 18 years old)

__________ Individual membership ($60)

__________ Household membership ($90) Second Member: ____________________

__________ Contributing ($100)

__________ Student ($15) - full time students

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Activities in which you would consider participating:

_____ assist in planning and implementing a citizen education program
_____ assist in planning and implementing a candidate forum
_____ participate in a voter registration drive
_____ review and type candidate survey data for Voter Guides
_____ participate on the LWVLC membership committee
_____ participate on the LWVLV fundraising committee
_____ assist with public relations to publicize LWVLC events
_____ attend some meetings (board, membership, citizen education events)

Source: lwv_lc web site 09/15/2012