MEMBERSHIP REGISTRATION FORM

Yes, I would like to join the League of Women Voters - Cuyahoga Area

______ $58.00 for Annual Individual Membership

______ $87.00 for Annual Household Membership (two persons)

Name ___________________________________________________________________

Address_________________________________________________________________

Telephone (home)_______________ (work) ________________ E-mail _______________

I would like to affiliate with the following Local Chapter(s) _____________________________

Check here if you would prefer being considered a member at large____________

Print and clip this form and mail it along with your check to LWV- CA, 50 Public Square #938, Cleveland OH 44113.