Membership Application

Please print this page, fill it out and send to the address below:

League of Women Voters of Blount County
3126 Rocky Waters Drive
Louisville, TN 37777

( ) I would like to join the League of Women Voters.

Enclosed is my check for: _____________
(Scholarships are available on request.)
 

In addition, I enclose my gift of: ___ $10 ___ $25 ___$50 ___$ 100 Other $ _____

I would like to contribute to:

( ) Operating Fund (mail check payable to League of Women Voters of Blount County)

( ) Education Fund (Tax deductible- make check payable to LWVTNEF)

Name: ____________________________________________________

Address: __________________________________________________

City/State/Zip: ______________________________________________

Phone: (H) ______________________
Phone: (W) ______________________

E-Mail: ___________________________________________________