2008-2009 Membership Form

Name:__________________________________ Birthday:

Address:___________________________________________________ Zip Code:

Home Phone Number:_______ Cell Phone Number:_

E-mail Address:_________________________________________________________________________

Occupation/Employer:_______ Work Phone Number:_

Spouse’s Name: Spouse’s Occupation/Employer:_____

How did you learn about Mt. Lebanon Junior Women’s Club? ______________________________________________

Please provide the names, birthdates and schools of your children:

Fun Facts for Profile

Where did you live before the South Hills? ___________________ ___ ___ How long have you lived here?__________

Where were you born? ________ _ ____

Hobbies/Other involvement? ____

Favorite Book/Movie? ____

Best Vacation? ____

Any other interesting facts you’d like to share? _____________________________________________________

_____________________________________________________________________________________

□ Please check box if MLJWC has permission to use photographs taken at any of our events or meetings for promotion of our club including: The Marker, MLJWC website or other materials.

Please make your check payable to MLJWC and forward to: Mt. Lebanon Junior Women's Club Attn: Amanda Beggy P.O. Box 13213, Pittsburgh, PA 15243

Dues: $50.00 Join May – December

Dues: $28.00 Join January

Name:____________________________________________________ Birthday: __________________

Address:___________________________________________________________ Zip Code:________

Home Phone Number:_____________________________ Cell Phone Number:_______________________