Name(s)______________________________________
                   ______________________________________
Address_______________________________________
City___________________________  Zip____________

Cell Phone__________________ Home Phone______________

Email(s)_________________________________________
           _________________________________________

Note: dues are currently prorated for a full year, dues renewal is in September:

First Member Dues (not deductible) ...................................$_____80.00__
Additional Household members (not deductible) .....,,,,,......$___________
($40 each,  a $0  student rate is available to anyone enrolled full or part-time at an accredited institution.)

Optional Non-Deductible Donation ......................................$___________

Total Non-Deductible amount:.........................................$___________
                                        make check payable to LWV Cupertino-Sunnyvale 

Optional Donation: LWV Education Fund (tax deductible) ...............$______
                                               make check payable to LWVC Education Fund  

Let us know your interests in participating in the League: 

___________________________________________________________________
___________________________________________________________________
___________________________________________________________________

LWVCS Membership form, valid until March 1, 2020