THE LEAGUE OF WOMEN VOTERS ^®
OF SMITHTOWN

Print this page, complete it, and enclose in envelope with a check payable to LWV of Smithtown.

Mail to Emerita Tiedemann, 4 Brillner Drive, Smithtown, NY 11780

First Name ________________________

Last Name _______________________________

Street Address _________________________________________

City ____________________________

State _________________

Zip ____________________

Home Phone ______-______-______________

E-mail ___________________________________

Please circle one of the following options.

Individual Membership $45

Household Membership $70

Student Membership $20

Additional Contribution $________

Education Membership $100 or more

(The education membership is tax deductible. Make the check payable to "LWV NYS Education Foundation"). 

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