Join Us! Membership Form Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneWork PhoneMobile PhoneEmail* Email Address Options I’d like to use this address for most communications including the newsletter Please send my newsletter and other league communications on paper, not via email Dues Levels* Basic ($40) Supporting ($50) Sustaining ($60) Student/Senior ($25) Additional Dues Options Family members: $15.00 for each additional member at the same address I would like to apply for a dues subsidy New member name suggestionsPlease feel free to invite potential members to any of our activities. A growing League is a strong League! To pay by check please mail your payment to: League of Women Voters of the Northampton Area P.O. Box 39 Leeds, MA 01053 Please make checks payable to: LWV of the Northampton Area