Membership

Lawton Council of the Blind

PO Box 7172, Lawton, OK 73506

Phone (580) 919-3343

Please mail the form below to the address above:

MEMBERSHIP FORM

NAME: ______________________________________

ADDRESS: ­­­­­­­­­­­­­­­­­­­­___________________________________

CITY, STATE, ZIP: ___________________________

E-MAIL: _____________________________________

PHONE(S): ___________________________________

ALT, PHONE (Cell, Work, etc.): _________________

BIRTH DATE: _________________________________

(Month & Day)