Now at LIMac:Brochure:Application

LIMac Membership Application

Please fill out and print out this form and mail it and a check for 12 months' dues to:

Donald Hennessy
140 Massapequa Ave.
Massapequa, NY 11758

Name:
Address:
City, State, Zip:
Home Tel.:
Office Tel.:
E-Mail:
Occupation:
How did you hear about us?
Any SIG of great interest?
Annual Dues: **
Membership type: New       Rejoin       Renewal

**Corporate membership includes membership
  for any five members of the corporation with
  two copies of newsletters sent to the corporate address.

Please make check payable to LIMac Inc.


Upon receipt of this form and your check,
a membership card and your first newsletter will arrive via first class mail. Welcome to the group.

Return to Home page | Back to Membership

This page last modified on 7/17/05.