LASHA Membership Application Form

Your Name (required)

Your Email (required)

Additional Member Name (if needed)

Additional Member Email (if needed)

Your Telephone

Your Address

Your Business Name (if applicable)

Check all that apply

Interested in sitting on Board/Committee:
Interested

Is this your permanent or seasonal home:
PermanentSeasonalBusiness

If Seasonal, permanent mailing address:

I would like:
Household Membership $40.00Supporting Business $120.00Business Membership $60.00

I would like to pay by:
Invoice Me I will pay by credit cardI will eTransferI will send a cheque

May we send you information about LASHA by email?
Yes PleaseNo Thank You

Any further Comment?

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