2008 CLUB MEMBERSHIP
Please print and fill out this page, then mail with your Check or Money Order payable to LSKC to:

Buddy Bush , LSKC Treasurer
13619 Keneva Dr
Cypress, TX 77429

Name(s):    ________________________________________
                  ________________________________________

Address: ________________________________________
             ________________________________________

City:       ________________________________________

State/Zip:  ________________________________________

e-mail address: ____________________________________

Home Phone:  ____________
Day Phone:     ____________

Do you have any special needs at this time?

Dues Level (please check one):                   Date: _____________
    Individual      $25  ______
    Family           $25  ______
    Corporate     $100  ______  (Includes business card ad placement in newsletter & website)