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Family of 4 adults: Membership Registration Form
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Membership Fee: $150
Note: Children aged 12 and over are considered adults for membership purposes.
Individual membership or Family membership
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Individual
Family
Your full name
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Your address
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Your contact number
*
Your email address
*
Upload Your Photo
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2nd Family member name
2nd Family member email address
2nd Family member contact number
Upload 2nd Family member Photo
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3rd Family member name
3rd Family member email address
Enter 3rd Family member contact number
Upload 3rd member Photo
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4th Family member name
4th Family member email address
4th Family member contact number
Upload 4th member Photo (if Family membership)
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Choose Payment Method
*
Zelle
Credit Card
Check
Please send a check for $150 to the address 1075 Shambliss Ln, Buffalo Grove, 60089 to complete your registration.
Membership fee is $150.Please proceed to provide your credit card details below to complete your registration.
Please Zelle $150 to lakecounty.indians1@gmail.com complete your registration and upload the payment completion screenshot below.
Membership Fee
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Upload Payment Receipt
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CONSENT:
By submitting this form, I confirm that all information provided is accurate and consent to LCIA to process the application and it can be treated as my electronic signature.
I Agree
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