League of Women Voters of Atlanta-Fulton County
MEMBERSHIP APPLICATION

Print and complete this form and mail with your payment or Credit Card Information to:

League of Women Voters of Atlanta-Fulton County
PO Box 420705
Atlanta, GA  30342

 New member    Renewal     Reinstate
Name ____________________________________________________________________
Address __________________________________________________________________
City ______________________________________ State _______ Zip ________________
Home Phone: ____________________ and/or Work Phone __________________________
E-mail ___________________________________________________________________

MEMBERSHIP DUES*
 Individual $60       Household $85    Full-time Student $30

Household Member Name ____________________________________________________

ADDITIONAL CONTRIBUTIONS
**Education Fund $______   Operating Fund $ ____   Other $ ______ (Specify __________ )

PAYMENT METHOD
 Check to “LWV Atlanta-Fulton County” enclosed

AREAS OF INTEREST AND SERVICE
  Voter service  Program  Public Relations  Fundraising  Membership  League Office

* Dues and most contributions are not deductible for tax purposes but may be deducible as ordinary and necessary business expense. 
** Educational fund contributions are fully tax deductible. Appropriate contributions should be noted in the check memo section.