Print this form, complete it and send with a check to
LWVPT
1 YWCA Place
Greensboro, NC 27401
Please check the area in which you wish to be involved during this year. You only need to spend 5-10 hours all year, unless you wish to spend more! The chair of the committee or his/her designee will call you.
---- Voter Service (Continues all year in preparation for the next election.)
---- Civics 10x (local government course for citizens)
---- Natural Resources
---- Membership
-----Public Education
---- Other (formed by interest of members)
Dues Enclosed for 2004 -- $56 (or $84.50 for two in a household).
$
_________
(Or $28 for students)
Contribution for general operations
_________
Total amount enclosed payable to LWVPT
$ _________
(Please print. If you do not use your first name, please underline the name used.)
Name (s) _____________________________________________________________
Address ______________________________________________________________
City ___________________________________________ Zip ___________________
Home Phone _________________ Work Phone ________________ FAX number
___________
Email address ____________________________
If you wish to make a tax deductible contribution to the Citizen Education Fund you may include a separate check and make it payable to Citizen Education Foundation and enclose it with your dues check.
Check PAYABLE to the Citizen Education Foundation (Tax Deductible) Amount $_____
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