Individual/Couple/Student Membership Form Fill out this section if applying for Individual, Couples, or Student MembershipStudent MembershipIndividualCouples*For couples, please place only both first names separated by the word "and".NameMailing AddressCityStateZip CodePhone(DAY)Phone(Evening)Cell PhoneEmailAre you currently enrolled in CollegeYesNoIf YES, Which CollegeInterested in doing Voluntary work?YesNoInterested in serving on a commitee?YesNoIf Yes, Which of the following:MembershipEntertainmentElectionBy-LawsYoung LeadersEducationHealth CareFood PantryYouth DevelopmentMinistryIf Yes, Which of the following:MembershipEntertainmentElectionBy-LawsYoung LeadersEducationHealth CareFood PantryYouth DevelopmentMinistryAny Special SkillSpecial InterestSponsor's NameCharityFood PantryHealth CareEducationYouth Development (M)Youth Development (F)MinistryMonthly Pledge$ 5.00$ 10.00$ 15.00$ 20.00$ 25.00CAPTCHA After you submit your application, please pay your dues by selecting your application type from the PayPal button below. Student Membership is Free Thank you! Membership Options Individuals : $50.00 USD - yearly Couples : $90.00 USD - yearly