Membership Form

On behalf of the people we support and their families, thank you for helping us to provide a safe, healthy and nurturing environment for all. Our community is a better place because of you.
— Judy Schelle, President, Lexington Board of Directors

Please enroll me as a 2014 member of Lexington - Fulton County Chapter, NYSARC, Inc.
Name *
Name
Address
Address
Phone
Phone
(all members must be at least 18 years of age)
Membership
$
Your membership is tax deductible. Make checks payable to Lexington or complete the credit card information below and return to:
Lexington Membership | 465 N. Perry St., Johnstown, NY 12095
Please charge my:
$
(from back of card)
Name
Name
(as it appears on card)
Billing Address
Billing Address