Membership Form

LRCGS, INC 

Membership Form

Send this form with your annual dues to:

LRCGS, INC. c/o Wynell Choate

P.O. Box 288

Ashdown Arkansas

71822

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Date________________________

Name _______________________________________________________

                  Last          First                 Maiden

Address ____________________________________________________

State,Zip __________________________________________________

                                                           

E-Mail  __________________________ _________________________

                                                 Phone #

Family/Household Membership_______________$20 (ex.husband/wife)

Single Membership________________$15

Donation___________________