LASR - Cheney Lake Association

Membership Application

Please Make Checks Payable to: Cheney Lake Association, 2500 Clairborn Cir., Wichita, Kansas 67226

NAME:

COMPANY:

ADDRESS:

CITY:
STATE:
ZIP:

HOME PHONE: BUSINESS PHONE:

YEARLY DUES:
SINGLE $25
FAMILY $35
SMALL FAMILY BUSINESS $60
CORPORATE $120
CORPORATE SPONSOR $250

TOTAL
$_______
$_______
$_______
$_______
$_______

$_______
Thank You For Your Participation
And Continued Support.
Chairman, Cheney Lake Association

CHENEY LAKE ASSOCIATION
2500 CLAIRBORN CIR.
WICHITA, KS 67226

LASR

Please Make Checks Payable to: Cheney Lake Association, 2500 Clairborn Cir., Wichita, Kansas 67226
NAME:
COMPANY:
ADDRESS:
CITY:	STATE:	ZIP:
HOME PHONE:		BUSINESS PHONE:
YEARLY DUES: SINGLE $25 FAMILY $35 SMALL FAMILY BUSINESS $60 CORPORATE $120 CORPORATE SPONSOR $250 TOTAL	$_______ $_______ $_______ $_______ $_______ $_______	Thank You For Your Participation And Continued Support. Chairman, Cheney Lake Association CHENEY LAKE ASSOCIATION 2500 CLAIRBORN CIR. WICHITA, KS 67226