First Name *

Last Name *

Which subdivision do you live in? (if applicable)

Address (Street, State, Zip Code) *

Date of birth *

Email *

Phone *

Are you interested in participating in any special projects?

Breakfast with Santa

Community Improvement Project

Grants/Scholarships

H.O.P.E. Community Clothing Closet

Local Politics Forum

Mental Health Symposium

Social Media/Website

How will you pay your membership dues? *

Credit card (next screen)

Check

Zelle

After submitting this membership form, you will be directed to pay your $60 annual dues via credit card. To pay via check or Zelle, contact ljwctreasurer@gmail.com for instructions.