Applicant Name

Subdivision   

Contact Phone or

E-Mail Address(es) or 

Property Address

Mailing Address 

City, State and Zip

Trash / Member Billing? yes or no I wish to receive Email trash and membership billing. I realize that it is my

responsibility to check for the bill at the beginning of each quarter. Not viewing the bill will not negate my responsibility for paying the bill

in a timely manner.

Newsletter via Email? yes or no I wish to receive the newsletter via Email. I realize that it is my responsibility to print and be aware of the information and announcements contained in the newsletter.

Additional Comments:

Please contact me as soon as possible regarding this matter.

         

          This form is for requesting Email communication from LEAPO

This form should be completed in full and forwarded to LEAPO

           All members of LEAPO may participate in the process of requesting Electronic Communications

 

          PARTICIPATION DOES NOT NEGATE THE PARTICIPANTS SUBJECT TO FEES AND PAYMENT OR DELINQUENCY

 

                                      

             Applicant Signature / confirm name                                                                              LEAPO Approval Signature

IMPORTANT NOTE; LEAPO does not share or sell any listings of membership or data pertaining  to membership to any business

or organization.