Past Lieutenant Governors Association Application

Life Member Application for PLGA

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Name*

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Primary Address*

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Email*

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District(s) served as Lieutenant Governor

Division(s) served as Lieutenant Governor

Year(s)

Other district or international offices held in Kiwanis

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Current position (if any)

Price for Life Membership

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If you are paying by check, please make your check payable to Florida District of Kiwanis and mail to: P.O. BOX 290489, Port Orange FL 32129

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