ABATE of Washington

ABATE of Washington
Membership Application Form
P.O. Box 1108
Centralia, WA 98531

NEW MEMBER

RENEWING MEMBER

1 year $30.00 enclosed

1 year $25.00 enclosed

3 years $70.00 enclosed

3 years $65.00 enclosed

5 years $105.00 enclosed

5 years $100.00 enclosed

Chapter: Lewis County

ABATE Member Number:

Expiration Date:

Original Join Date:

Name:

Address:

City:

State: Zip:

Phone:

E-Mail:

Registered Voter in WA State? yes

Legislative District: Precinct:

Signed Up By:

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Send your check payable to LC ABATE along with this form to the address at the top.
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