Leading the Way for Voters!                   Membership Form

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

Name:  ____________________________________________________

Mailing Address:  ____________________________________________

                           _____________________________________________

                           _____________________________________________

 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