Membership Application...

LIDGS MEMBERSHIP APPLICATION

Annual Membership (Feb 1- Jan 31_

Date:_______________________

Check One:________Individual $20.00

                   ____Family $20.00 for first member, $10.00 each additional member living at the same address

                  ____Junior member $5.00(ages 13-17)

Name:___________________________________

Address:_________________________________

City:________________State_________Zip________

Phone: _______-___________________

Please enclose check made out to: LIDGS with a stamped, self addressed envelope and mail to : LIDGS, Box #148, West Sayville, NY 11796