Pacific Northwest  District

Past Lt. Governors Association

“BIGFOOT BRIGADE”

                 

2017-2018 Membership Application

 

 

NAME________________________________________________ PHONE________________­­_­_____

 

 

 

ADDRESS_______________ ____________________________________________________________

 

 

 

CITY_______________________________________________St/Pr________ZIP_________________

 

 

 

EMAIL______________________________________________________________________________

 

 

 

CURRENT CLUB____________________________________________________DIV#____________

 

 

 

LT. GOV. YEAR_____________________DISTRICT______________________DIV#____________

 

Ø Dues:  $5 Yearly or $75 LIFETIME ($50 age 70 or above) payable to:

 

                                    Past Lt. Governor’s Assn.

                                    c/o PNW District Kiwanis Intl. Office

                                    5427 Glen Echo Avenue    

                                    Gladstone, OR 97027-2627

 

 

 

                              Thank You, For All Your Support!!!

 

This is a receipt of dues paid and Bigfoot Pin in possession

Ck#/Cash             Date             Pin: Yes / No             Signed