LCC Radio Membership Form

Print, complete, and mail to:

LCC Radio Membership Coordinator
PO Box 40010
Lansing, MI  48901-7210

or call (517) 483-1710 during regular business hours, Eastern Time

First Name_____________________ Last Name _____________________________

Address ______________________________________Apt #_______________

City ______________________ State ___ ZIP___________ Phone _______________

Date of Birth ___________Email Address  or website__________________________________

Last edited: Tuesday, March 05, 2013