Membership Form

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

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Membership Interest and Dues Payment Form 2008-2009

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 7/1/2008)

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. Talvitie Membership Scholarships available upon request to and approval from League President)
2. If you are joining the League as a new member after January 31st., pay half price for the remaining year.
Contribution: Contributions to the Citizen Education Foundation (CEF), are especially needed.
$______payable to LWVODC (In addition to dues, for general LWVODC operating expenses. May be included on same check with dues payment. This contribution is Not Tax Deductible.)

$______payable to Citizen Education Foundation or CEF. (For educational purposes only. This contribution must be on a separate check and is Tax Deductible.)

$______payable to LWVODC (For the "Talvitie Membership Scholarship Fund" to sponsor current and new members. May be included on same check with dues payment. This contribution is Not Tax Deductible.)

INTEREST SURVEY

I would like to help with (check all that apply):
______ Voter Education
______ Forums (Educational/Political)
______ Editing the Newsletter
______ Health Care Reform
______ Campaign Finance Reform
______ Membership Greeting/ Recruitment
______ Affordable Housing
______ Tax Laws
______ Education
______ Organizing discussion on hot topics
______ Immigration Reform
______ Other (please specify:

Comments, suggestions, questions? Contact our webmaster. Last revised: October 9, 2008 11:02 PDT.