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LMC APPLICATION
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Send to:
603 Brandt Ave. 
New Cumberland, PA 17070

Make the check payable to Wanda Wilson LMC.

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Required Information - Please Print Clearly
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First Name:_________________________________________

Last Name:__________________________________________

Address:____________________________________________

City:_________ State:________ Zip Code:____________________________

E-Mail:_____________________ Phone:_________________

[ ] I have enclosed a check for $25.00 for a one year
membership to the LMC.

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Optional Personal Questions:
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Age: (Check Appropriate One)
[ ] I'm a Kid
[ ] Adult - Not too Mature
[ ] Mature Adult
[ ] Older and Wiser
[ ] Elderly
[ ] None of the Above

Birthday (mm/dd/yy) (year optional) ____/____/____

I live...
[ ] In a big city
[ ] near a big city
[ ] in a small town

Nearest Major Airport:_____________________________

Rank In Order (1=best, 12=worst)

[  ] Rats: 
[  ] Snakes: 
[  ] Dormice: 
[  ] Spiney Mice: 
[  ] Cats: 
[  ] Ferrets: 
[  ] Mice: 
[  ] Birds: 
[  ] Zebra Mice: 
[  ] Deer Mice: 
[  ] Dogs: 
[  ] Possums: 

My own Pets Are:___________________________________

___________________________________________________

My Occupation Is:__________________________________

Company:______________________ For How Long?_______

I have mice:
[  ] To Show
[  ] To Sell
[  ] To Breed
[  ] Because they're there
[  ] I Dunno
Other: ____________________________________________

___________________________________________________

If I had a million dollars, 
I would spend it on..._____________________________

___________________________________________________

I guess the most interesting 
thing about me is..._______________________________

___________________________________________________

I wish our group would...
[  ] Be Better Organized
[  ] Have More Newsletters
[  ] Quit Wasting Money On Newsletters
[  ] Have More Meetings
[  ] Have Meetings That I Could Get To
[  ] Quit Bothering Me About Meetings
[  ] Have More:___________________________________

Could you help rescue animals with:
[  ] Large Vehicle
[  ] Making Phone Calls
[  ] Being a Distribution Point
[  ] Donating Gas, Money, Etc..
[  ] Other:_______________________________________

(we have had six or more instances in the club where 
breeders (over 50 cages) had to suddenly place their 
animals elsewhere)

Nearest Major City:_________________________________

Means of Transportation:____________________________

Additional Comments:________________________________

____________________________________________________

____________________________________________________

____________________________________________________

____________________________________________________

    Source: geocities.com/heartland/ranch/3220

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