WLPA Printable Order Form

Personal Information

Name:__________________________________

Address:________________________________

City:_____________________ State:_____________ Zip Code:________

Phone:_________________

Current Membership Number:___________________ 

General - $35.00____
Family $50.00____
Student $25.00____ (a photocopy of your student ID is required)

General $35.00____
Family $50.00____
Student $25.00____ (a photocopy of your student ID is required)
Lifetime $1000.00____
Multiple Lifetime $5000.00____

Official WLPA T-Shirts - $25 (Current Members: $20 - please provide membership # above.)
Available Sizes: Large___     XL___     XXL___

WLPA 'Quill and Sword' logo buttons - $3.00___

Please print this sheet and return it, with donation, to:

•  For group or coven memberships, please e-mail or write us for more information.
• Membership donations cover the member(s) from January 1st-December 31st (renewals are due by December 31st).
• Membership donations for applications after July 1st are reduced by half.