Enclosed is my annual membership payment, payable to LWV Brookfield
$50 for single, $80 for household
Scholarship support (optional) $________
Name _______________________________________________
Address _____________________________________________
City & Zip ____________________________________________
Phone: Home _________________________________________
Business _______________________________________
E-mail ______________________________________________
Mail to:
LWV Brookfield
P.O. Box 652
Brookfield, CT 06804
E-mail: LWVBrookfield@lwvct.org
Membership dues and contributions to LWVCT are not deductible as charitable contributions for tax purposes.