---------------- LMC APPLICATION ---------------- Send to: 603 Brandt Ave. New Cumberland, PA 17070 Make the check payable to Wanda Wilson LMC. ----------------------------------------------- Required Information - Please Print Clearly ----------------------------------------------- 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. ---------------------------------------------------- Optional Personal Questions: ---------------------------------------------------- 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:________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________ ____________________________________________________