LGCHS Membership Application
Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
Email
Birthday:
Spouse's Name:
Occupation:
What are your herp interests?
Please select your membership premium.
LGCHS Shirt - Small
LGCHS Baseball Cap
LGCHS Shirt - Medium
LGCHS Floppy Hat
LGCHS Shirt - Large
LGCHS Shirt - XLarge
LGCHS Shirt - XXLarge
Please select the LGCHS activities that interest you.
Education - Presenting to schools & other groups - Public awareness
Events - Event planning - Working at reptile shows and events
Legislature - Working with the LGCHS legislative committee
Membership - Help enlist and educate new members
Newsletter & web site - Gather & publish information
Other:
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