2023 LWVJC Membership Registration

LWVJC Membership Registration

NOTE: this is a membership form for League of Women Voters of Johnson County, Iowa.
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Are you a new member or renewing your membership?*

New memberRenewing membership

Would you like to register another member in your household?*

YesNo

Name of additional member in your household:*

First NameLast Name
Email address of member*
example@example.com
Phone number of member

Area CodePhone Number

If paying by check, please make payable to "LWVJC" and send to:

LWVJC
PO Box 5452
Coralville, Iowa 52241

Individual membership: $70.00
Household membership: $105
Student membership: $20.00

Once you click submit, your form will be sent to the Membership Chair.

If paying online, please follow the Square prompts once you click "submit" below. We use Square to handle online transactions via credit or debit card. A Square account is NOT required to submit payment to LWVJC. On the following screen, click "pay by credit or debit card."

Thank you for your support of LWVJC! We hope to see you at a League event soon!
Please choose payment option*

Credit or debit cardPay by mail with check

My Products

Individual Membership ($70 if paying by check, $72.50 if paying online)$72.50

Household membership ($105 if paying by check, $108.50 if paying online)$108.50

Student Membership ($20 if paying by check, $21 if paying online)$21.00

Total $0.00

Credit Card

Should be Empty: