Lithuanians of America 2008 Dues

___ $10 - family ___ $7 - single ___ Additional Contribution of $_____

Name:______________________________________________________________________

Address:____________________________________________________________________

City:_______________________________________ State:________ Zip:______________

Phone:(_____)_____-________

Print and Mail to: LOA, 1731 N. 78th Terr., Kansas City, KS 66112