LEAGUE OF WOMEN VOTERS BLACK HAWK-BREMER COUNTIES
MEMBER INFORMATION FORM
NAME: __________________________________________DATE____________________
ADDRESS:________________________________________________________________
_________________________________________________________________________
TELEPHONE: ________________________EMAIL: _______________________________
I would like to receive League announcements
_____By Phone ______By Email
MEMBERSHIP DUES/CONTRIBUTIONS:
YES,
I would like to support the League of Women Voters Black Hawk-Bremer in their
work of encouraging citizens to participate
in their government.
[Check all that apply. You are welcome to be both a member and a donor.]
As a Member: (membership year begins July 1)
Individual Membership $60 ____________
Household Membership $30 for each additional member ____________
Student Membership $20.00 ____________
Low-income Membership (to be approved by the Board) ____________
(“Low income”
is defined as those eligible for Energy Assistance)
(Check to: “League of Women Voters Black Hawk-Bremer”)
As a Donor:
I would like to make a donation directly to League of Women Voters
Black Hawk-Bremer. This donation is not tax-deductible. ____________
(Check to: “League of Women Voters Black
Hawk-Bremer”)
I would like to make a tax-deductible donation to the Community
Foundation of Northeast
Iowa ____________
(Check to “Black Hawk County LWV Endowment Fund”)
I would like to make
a tax-deductible donation to Cedar Falls
Civic Foundation
(Check to “Cedar Falls Civic Foundation-Carol Cooper)
____________
TOTAL: ____________
Mail your check/s to:
Francesca Soans, Membership
2035 West 3rd Street, Waterloo, IA 50701
SERVICE:
I am interested in volunteering for the following activities (check
all that apply):
__organize programs
__voter registration
__publicity of League events
__membership recruitment
__fundraising and development
__candidate forums
__legislative forums
__Partners-in-Education - Hoover
__I cannot commit to any specific activity at this time but would like to stay informed about
League activities
