Fill in the information below and send it in with your
membership dues. Thank you and keep in touch.
Name: _______________________ Position:
______________________
County of Employment: ____________________
Address: _____________________________________________________
_____________________________________________________________
Phone: ______________________
Email: _________________________
Annual Dues: $20.00
Send completed form and dues to:
Ed Hernandez, WALCE Treasurer
Waushara County LCD
209 S. St. Marie St.
Wautoma, WI 54982