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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