| Names | ________________________________________________________________________ |
| Address (1) | ________________________________________________________________________ |
| Address (2) | ________________________________________________________________________ |
| Telephone | ________________________________________________________________________ |
| Fax | ________________________________________________________________________ |
| ________________________________________________________________________ |
| Membership (18 years old or older, U.S.citizen, voting) | $55.00 | $__________ |
| Additional household member(s), each at | $22.50 | $__________ |
| Associate membership (under 18 years old or non-U.S. citizen, full participation, non-voting) | $55.00 | $__________ |
| Additional household member(s) | $22.50 | $__________ |
| I wish to add a contribution to the League (not tax deductible) | $__________ | |
| I wish to add a contribution to the League of Women Voters of Howard County Education Fund (tax deductible) | $__________ | |
| TOTAL | $__________ |
| Please make your check payable to LWVHC
and mail to: League of Women Voters of Howard County Suite 301, Century Plaza 2000 10632 Little Patuxent Parkway Columbia, MD 21044 |
Revised 05-01-03