Lambda South, Inc.

P.O. Box 030339
Ft. Lauderdale, FL 33303-0339
(954) 761-9072 (Office)
e-mail: info@lambdasouth.com

Membership
Please include your payment and drop in collection basket, mail to the address above, or drop in the drop-safe next to the lockers.

Name: __________________________________________

Address: ________________________________________ ________________________________________________ ________________________________________________

Phone: (        )_____________________________________

Recovery Date: ___________________________________

I am a: New Member        Current Member

Amount Enclosed: $_________________________________

For Months of _____________________________________ (The enclosed payment will be automatically applied to Dues that are in arears unless otherwise specified)

Do you wish to be on the share and care list? Yes       No

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