Membership Form

To join LWVGGR or renew your membership, please fill out the form.

If you choose to pay with a credit card, you will be redirected to PayPal.

If you choose check, a PDF will be emailed to you. Please print and send, along with your check (made out to LWVMI), to:
LWVGGRA
PO Box 174 
Belmont, MI  49306-0174

Membership Form_PAYPAL

Name *

Street Address *

City *

State *

Zip *

Phone *

Email

Is this a… *

New Membership

Renewal

How would you like to pay?

*

Check

Card/Paypal

Note: If you pay by credit card, you will be charged an additional 3.612% + $0.49 fee to offset credit card processing.

Annual Membership Type (Dues are NOT tax deductible)

Single ($70)

Household (2 adults at the same address, $105. For each additional adult, please add $35 and include their name and email at the bottom of the printed PDF.)

Student (Full or Part Time, $0)

When paying by check, please print out the form emailed to you upon completing this form and mail it with your check to:
LWVGGRA
PO Box 174, Belmont, MI 49306

Annual Membership Type (If you pay by credit card, you will be charged an additional 3.612% + $0.49 fee to offset credit card processing. – Dues are NOT tax deductible)

Single – $70

Household – $105 (2 adults at the same address.)

Household – $140 (3 adults at the same address.)

Household – $175 (4 adults at the same address.)

Student – $0

2nd Household Member Name

2nd Household Member Email

3nd Household Member Name

3nd Household Member Email

4th Household Member Name

4th Household Member Email

Comments/Involvement Interests

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