Membership Application Form

LSKC Membership Application

Please print and fill out this page, then mail with your check or money order payable to LSKC to:
Joanie Patterson
LSKC Treasurer
1618 New Orleans St
Deer Park, TX 77356

Name(s):

 ________________________________________
________________________________________
Address:
City:
State/Zip: 		________________________________________
________________________________________
________________________________________

Email Address:
Phone:

 ________________________________________
________________________________________

Do you have any special needs at this time?

 ________________________________________

Dues Level
(Please check one)

 Individual $25 ______
Family $25 ______
Corporate $100 ______ (Includes business card ad placement in newsletter & website)

If you have any question, please contact the Treasurer at 832 729-3477.