THE LIGHTHOUSE LIVING ENRICHMENT SOCIETY A Beacon of Hope!
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Membership Application Form

Please print this page and send it to....

Name _________________________________________________________________

Address: Number and Street __________________________________________

City, Province and Postal Code __________________________________________

Phones - Home: __________________________ Work: __________________________

Cell: __________________________ Fax: __________________________

Email Address: ______________________________________________________

How might you like to participate in the Lighthouse Living Enrichment Society?

Membership fees for 2010 are $20.00.

Method of Payment:

Cash: __________

Cheque: __________

Please note that all membership applications are submitted to the Board for approval.