Lake Havasu City Alano Club

Membership Application

Date:___________

Name_________________________________________

Street or P.O. Box:_______________________________

City, State, Zip______________________________________

Telephone: (    )________________________

Email:____________________________________

A.A. or Anniversary Date:_____________________

Sponsor:________________________________(who referred you)

Applicants Signature: _______________________________

If you would like to serve on a committee, please circle one:

       Fundraising/activities            Concession/Kitchen        Maintenance/Operations

Dues (circle one) Payable by the 7th of each month, when paying by month.

                 $10.00/month       $55.00/six months          $100.00/year

Send to:

 Lake Havasu City Alano Club.

 P.O. Box 922,       L.H.C. AZ 86405-0922