Pacific Northwest District
Past Lt. Governors
Association
“BIGFOOT
BRIGADE”
2017-2018 Membership
Application
NAME________________________________________________
PHONE______________________
ADDRESS_______________
____________________________________________________________
CITY_______________________________________________St/Pr________ZIP_________________
EMAIL______________________________________________________________________________
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
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