Lyceum Club of Tarrytown - RENEWING Member Form

Lyceum Club of Tarrytown - Membership Renewal form

For members in good standing who wish to renew for the current year.
Type of Membership
Date

MonthDayYear
Date
First Name
Last Name
First & Last Name
Street Address
City
State
Zip
Date of Birth

MonthDayYear
Date
Email address
example@example.com
Phone Number

Area CodePhone Number
Current Occupation
Please provide LCT with details about yourself (family, interests, hobbies, etc)
Please initial below to acknowledge your acceptance of the Lyceum Club of Tarrytown's rules and regulations for RETURNING members:
I understand that annual dues of $500 must be submitted upon completion of this form.
I understand the member accounts must be up-to-date before membership can be renewed for the current year.
I verify that the information provided above is accurate to the best of my ability.
Signature
Full Name
LCT Fees:
prevnext( X )
Lyceum Club of Tarrytown - Annual Dues
Annual fee for all members.

$500.00 Quantity

Total

$0.00
I will submit payment via:
Amount Paid:
Date

MonthDayYear
Date

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Lyceum Club of Tarrytown - Membership Renewal form