ECONOMIC CLUB OF LAPEER COUNTY INDIVIDUAL MEMBERSHIP

Individual Membership Fee: $200

Miss	Ms.	Mrs.	Mr.
Enter your name:
Company:
Title:
Number of Employees:
Type of Activity:
Office Street:
Office City:
Office State:
Office Zip:
Home Street:
Home City:
Home State:
Home Zip:
E-mail address:
Include in membership directory:	Yes	No
Office Phone:
Home Phone:
Send Mail To:	Office	Home
Sponsor a luncheon ($500):	Yes	No
Sponsor a school to attend a luncheon ($40):	Yes	No

Please return application and check payable to Economic Club of Lapeer County.
Thank you for your support.