Larchmont Newcomers Club: Online Form: LNC Online Member Enrollment Form

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LNC Online Member Enrollment Form

1. Member Information

*First Name:		*Last Name:
Spouse/Partner's Name (if applicable):		Last Name:
*Address 1:
Address 2:
*City:		State: Zip:
*Email Address:
*Please note that in order for you to receive your Username and Password to the members-only section of the site, we need to have an accurate email address for our records. Your Username and Password will be emailed to the address provided. All Club correspondence will be emailed to that address as well. Please check for accuracy.
*Home Phone:	(xxx) xxx-xxxx
Work Phone:	(xxx) xxx-xxxx
Cell Phone:	(xxx) xxx-xxxx
*Preferred Phone:	Home Work Cell

2. Member Profile

Marital Status:		Moved From:
Ages of Children (if applicable):

3. Membership Type

New Renewal

*Membership Dues (Select One):
Single $35
Family $55
Gold Single $23 (have held LNC single membership for more than 3 years)
Gold Family $35 (have held LNC family membership for more than 3 years)
Past President

After you submit your online form, you will be directed to PayPal to pay your dues and complete your Membership Enrollment. If you do not have a PayPal account, you may open one. If you do not have a PayPal account and would prefer to mail in your form and dues, please do not submit an online form. Click here and you will be directed back to our Application page. Thank you!

4. LNC Information

How did you hear about LNC?

Primary reason for joining LNC:

Are there any products, services, time or skills that you would be willing to donate to LNC? If so, please specify:

Would you ever be interested in volunteering on the board at some point?

Larchmont Newcomers' Club
P.O. Box 943 Larchmont, NY 10538
mail@larchmontnewcomersclub.com

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