LEA Membership Signup & Payment

By check

Membership options

Annual Membership for 1st lot $150.00

150 per lot + processing feeMaximum is 1

Additional Donation Minimum is $10Input amount must be more than minimum

Extra Tags (membership includes 3 tags) $5/tagInput amount must be more than the minimum.

Total: $150.00 USD

Please select at least one amount item.

Member InformationBold field is required input

TitleTitle is Required

Custom TitleTitle is Required

First NameFirst Name is Required

Last NameLast Name is Required

CompanyOrganization NamePlease input Company Name

AddressAddress is Required

CityCity is Required

CountryCountry is Required

StateProvinceStateProvince is Required

ZipPostal CodeZipPostal Code is Required

PhonePhone is Invalid

MobileMobile is Invalid

Fax

EmailEmail is Required

Please Re-enter EmailEmail address entries must match.

Please highlight any information that needs to be updated in our system.

Lot #'sThe Lot #(s) associated with this payment

Additional emails

Additional emails you would like to receive notifications and membership on

Products/Services - I can offer...Keep it in the neighborhood?

Volunteer - willing/able to assist withHelp a neighbor?

Item 5Item 5 is Required

Item 6Item 6 is Required

Item 7Item 7 is Required

Item 8Item 8 is Required

Item 9Item 9 is Required

Item 10Item 10 is Required

Item 11Item 11 is Required

Item 12Item 12 is Required

Item 13Item 13 is Required

Item 14Item 14 is Required

Item 15Item 15 is Required

One TimePlease select to pay dues annually

ErrorMsgDiv Description

Annual dues - Pay by check