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
Date________________________
Name _______________________________________________________
Last First Maiden
Address ____________________________________________________
State,Zip __________________________________________________
E-Mail
__________________________ _________________________
Phone #
Family/Household Membership_______________$20 (ex.husband/wife)
Single Membership________________$15
Donation___________________