Membership Application
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Last Name
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First Name
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Middle Initial
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Nickname
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LG Class #
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SIMSOC Color
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Home Address
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City
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State
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Zip Code
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Home Phone #
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Work Phone #
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E-mail Address
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Occupation (Title/Position)
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Company or Firm
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Work Address
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City
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State
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Zip Code
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I prefer my Leadership Gainesville Alumni Association mail be sent to: ___Work or ___Home
I have an interest in serving on the Leadership Gainesville Alumni Association Board: ___ Yes
Please check one:
___ I am new member (I have never been a member of LGAA) ($50)
___ I am renewing my membership ($50)
Method of Payment: (please check one)
___ Check enclosed (payable to Leadership Gainesville Alumni Association, Inc.)
___ Visa ___ MasterCard ___ Discover ___ American Express
#: _________________________________________________
Expiration Date: ______________
Signature: ___________________________________________________
Security Code: (3 digits on back of card) _______
Member Benefits
Tiger Bay • Networking Opportunities â— Leadership Training & Opportunities
Thank you for your support of Leadership Gainesville Alumni Association!
For more information contact:
Kim Tesch-Vaught, LGAA President 352.334.7105 ext. 304
Kim Mitrook, LGAA VP Membership 352.854.4145 or Jan Patterson, Chamber Liaison 334.7105 ext. 323
Return to: Leadership Gainesville Alumni Association, Inc.
Attn. Jan Patterson
PO Box 1561 Gainesville, Florida 32602
FAX: 352.334.7141
