LYC-SEATTLE NEW MEMBER APPLICATION

LYC Seattle New Membership Application

Please enroll me as a member of the Long Yang Club. By completing this application, I certify that I am over the age of 18.

Membership Renewal?

Individual (US$20)

Couple (US$30) One Mailing Address

Corporate (US$75) One Representive

FIRST NAME:

LAST NAME:

ADDRESS1:

ADDRESS2:

CITY:

STATE/PROVINCE:

ZIP/POSTAL CODE:

PHONE: (Area Code - Number)

PAGER: (Area Code - Number)

CELLULAR: (Area Code - Number)

EMAIL:

PERSONAL HOME PAGE

PREVIOUS LONG YANG CLUB MEMBER? Yes
No

HOW WOULD YOU LIKE TO BE LISTED IN THE MEMBERSHIP DIRECTORY? All information
Email and Phone Only
Email Only
None

Instructions:

Print out this form before you hit the submit button.

Mail form with your appropriate membership dues to:
LYC-Seattle
PO Box 20545
Seattle, WA 98102

(Please do not send cash)

If you experience any problem on this form, please email: webmaster.seattle@longyangclub.org

FIRST NAME:
LAST NAME:
ADDRESS1:
ADDRESS2:
CITY:
STATE/PROVINCE:
ZIP/POSTAL CODE:
PHONE: (Area Code - Number)
PAGER: (Area Code - Number)
CELLULAR: (Area Code - Number)
EMAIL:
PERSONAL HOME PAGE
PREVIOUS LONG YANG CLUB MEMBER?	Yes No
HOW WOULD YOU LIKE TO BE LISTED IN THE MEMBERSHIP DIRECTORY?	All information Email and Phone Only Email Only None