LLHS Membership Application

Check one:*

New MemberCurrent or Renewal with changes to my membership

Name*FirstLast

AddressStreet AddressAddress Line 2CityState Postal / Zip Code

U S A

Day/Evening Phone

Cell Phone

Member E-mail (required)*

Is this membership a GIFT for someone?*

Yes

If this membership is a GIFT FOR SOMEONE, please give us your name:

How would you like to receive "The Cornerstone", our monthly newsletter?*

Electronically by e-mail

Hard copy through the US Post Office

Every month we wish our members a Happy Birthday by listing their names in "The Cornerstone." Would you like to be included for your birthday month?*

Yes - List your name(s) and birthday month(s)

No, do not include me

Name(s) and birthday month(s)

MEMBERSHIP LEVEL (when you click the submit button, you will be directed back to the membership page where you can use your charge card or PayPal to make payment).*

LIFETIME-The Marshall $2,500 and aboveBENEFACTOR-The Roberta $1,000 / yearPROTECTOR-The Viola $500 / yearPRESERVER-The Harry $250 / yearBUILDER-The George $100 / yearSPONSOR $50 / yearBASIC Couple/Family/Household $30 / yearBASIC Individual $20 / yearBASIC Student (up to age 20) $10 per student / year