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2011 Membership Renewal
Legal Name(s):
| (1) _________________________________ (2) ________________________________ |
| Nick Names (if applicable) (1) _____________________
(2) ____________________ |
| Email address (1) ___________________________ (2) _____________________________ |
Renewal Type (due January 1 for each calendar year):
| ___ Single |
___ Couple (at same address, one copy
of newsletter) |
Payment Amount:
| ___ |
I (we) wish to renew my (our) membership for 2011 and continue to
receive the monthly e-mail newsletter. Enclosed is a check for the $20 single or $30 couple, payable to LANG.
(must be received by March 1) |
| ___ |
My (our) membership expired in 2009 or 2010. I (we) wish to rejoin for 2011 and
receive the monthly e-mail newsletter. I was(we were) a member in good standing at the time my (our) membership
expired. Total payment is $25 single or $35 couple. Note: past members whose membership expired prior to 2009
must submit a new application and cannot rejoin using this form. |
| ___ |
I (we) do not wish to renew my (our) membership or continue to receive monthly newsletters. |
Host or co-host fulfillment:
LANG is an all volunteer organization. Service to the club, as either an event Host or a Co-host,
once a year is a requirement for membership. My (our) preference for service is:
| Please place my (our) name(s) on the co-host team for the month of: _______________ |
| or, I (we) will host a party in the month of: ________________ |
Address / phone / other changes, if any:
| Address ________________________________________________________ |
| City _______________________________ State _______ Zip _____________ |
| Telephone (home) _____________________ (other) ______________________ |
DO NOT send cash. Please be sure to note any corrections
to your address or telephone number. Please print, fill out and mail this form with your renewal check attached to:
LANG, PMB 249, 8424A Santa Monica Blvd., West Hollywood, CA 90069.
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