Membership Application & Renewal MEMBERSHIP OPTIONSLEADA Membership: $10 per Member Membership Form PDF Membership Form .docx Choose your Membership* New Resident Membership - Join $10 New Friends of Lakes Membership - Join $10 Annual Membership Donation How many Memberships?*Select how many Members you are renewing or signing up. One Member Two Members Three Members Four Members Five Members Six Members Name* First Last Name 2* First Last Name 3* First Last Name 4* First Last Name 5* First Last Name 6* First Last Business Name (if applicable) Type of Business Phone Landline Mobile Email* Town/City How did you hear about us?* Word of mouth Internet Search Local Newspaper Refer A Friend Email LEADA Newsletter Poster around town Total $ 0.00 Payment Options Credit Card Bank Deposit Recurring Payment?*I am happy for LEADA to automatically debit my credit card with my $10 donation each year until I notify that I wish my donation to be discontinued. Note: You will be advised of this in advance each year. Yes, recurring No, once off payment Credit Card*Card Details Cardholder Name Account Name: LEADA BSB: 063 832 Account: 1017 3664 Please use Surname as Reference.CAPTCHA
