Membership Form

League of Women Voters^®
of Orange-Durham-Chatham

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Membership Interest and Dues Payment Form 2010-2011

Please complete form, make membership dues' check payable to LWV-ODC, and send both to: LWV-ODC, P.O. Box 3397, Chapel Hill, NC 27515-3397
DATE_____________________________
______NEW ____RENEWAL (Renewals are due by 7/1/2010)
Name(s) ____________________________________________
Address ____________________________________________
City/State zip+4____________________________________________________

Phone ___________________E-mail ___________________

County of residence ______________________

Municipality (if within city limits) _____________

DUES:
Check type of membership below:
$______ Individual ($55) (with VOTER sent through regular mail = $65)
$______ Household ($82.50) (with VOTER sent through regular mail = $92.50)
$______ Full-Time Student ($30)(with VOTER sent through regular mail = $40.00)
Notes:
1. Membership Scholarships available upon request to and approval from League President or A-Team Leader.
2. If you are joining the League as a new member after January 31st, you can pay half price for the remaining year.
CONTRIBUTIONS
The Citizen Education Foundation (CEF) is the 501(c) (3) citizen education and research arm of the League of Women Voters of North Carolina. CEF provides research, publications and forums on public policy issues. It disseminates information and training to help citizens be thoughtfully engaged in the democratic process. CEF funds may be used only for educational activities, not for advocacy or action.
We can use your tax deductible contribution to CEF to pay our PMP (Per Member Payment) to the US League of Women Voters to support their educational work.
Contributions to LWVODC (not tax deductible and may be included on same check with dues payment):
$______For general LWVODC operating expenses.
$______For the Membership Scholarship Fund to sponsor current and new members.
Tax Deductible Donation to Citizen Education Fund (make separate check payable to CEF):
$____Total CEF Fund
INTEREST SURVEY
I would like to help with (check all that apply):
______Voter Education/Registration
______Forums (Educational/Political)
______Editing the Newsletter
______Membership Greeting/Recruitment
______Immigration
______Campaign Finance Reform
______Health Care
______Citizens Guide
______Water Quality
______Affordable Housing
______Tax Laws
______Education
______Organizing an evening/afternoon/morning discussion on hot topics
What issue? ______________
______Other (please specify):___________

Comments, suggestions, questions? Contact our webmaster. Last revised: July 22, 2010 14:45 PDT.