LCGT Membership/Gail Rutan
20060 Judicial Road
Lakeville, MN 55044

Name(s)_________________________________________ Date ____________________

Address _________________________________ City ____________________ Zip _____

Telephone (home) ___________________________ e-mail __________________________

Child's name & school _____________________________________ Year of graduation ____

Child's name & school _____________________________________ Year of graduation ____

Child's name & school _____________________________________ Year of graduation ____

Check as many as apply: New member __ Renewal __ Parent__ Teacher__ Change of address__

Please read and sign the following:

I understand that half of my $35 annual dues goes to our state council, MCGT

and half to our local chapter, LCGT.________________

May we print your name in LCGT News as a new member? Yes___ No___

Volunteer Participation Information: I could help out the chapter in the following ways:

• ____ Helping to plan our future meetings.
• ____ Seve as the school representative for ____________________ School.
• ____ Call me as needed.