GREATER LEXINGTON NEWCOMERS CLUB

www.lexvanewcomers.org

APPLICATION FOR NEW MEMBERSHIP:

I certify that I have been a resident of Rockbridge County for no more than 5 years, and that I am presently residing in Rockbridge County or have a Rockbridge County mailing address (or a city or municipality in Rockbridge County).

Date of Application: ___________

Applicant:

Last Name __________________________ First Name _______________ M.I.________

Spouse or Other Person Living in Same Household:

Last Name __________________________ First Name _______________ M.I.________

Address1 ___________________________________________________________

Address2 ___________________________________________________________

City _______________________________________________________________

Zipcode _______ Telephone _______________________________

Email Address:______________________________________________________

SIGNATURE______________________________________________________

RENEWAL OF MEMBERSHIP:

Name __________________________________________________

Street __________________________________________________

City: ____________________ Zipcode _______

Telephone ______________________

Email Address ______________________________

For new membership or renewal,

please return form with $25.00 check payable to

Greater Lexington Newcomers Club to:

Bill Docekal, Membership Chairperson

91 Reese Ridge Lane

Lexington, VA 24450

Telephone: (540) 261-3421