I, ________________________________ , the
undersigned, agree to Bylaws and Service Agreement of the La Cañada Wireless
Association (LCWA) and desire to become a Member of the Association.
1) I have received and read the LCWA Bylaws.
2) I have received and read the LCWA Service
Agreement.
3) I have paid the Membership Fee of
$___________ that entitles me to be a Member of LCWA.
4) I understand that a Monthly Fee (currently
set at $___________) will commence within 30 days of my first access to the
LCWA Network and is payable under the terms of the Service Agreement.
5) I understand that the monthly fee may change
at any time, per the conditions set forth in the Service Agreement and Bylaws.
My signature below and the LCWA’s receipt of
funds from me that are applied against the Membership Fee shall constitute my
agreement with the terms herein.
Authorized
Member Signature: _________________________________ Date: ______________
Printed Name: _________________________________________________________________
Business Name
(if applicable): ____________________________________________________
Service
Address: _______________________________________________________________
Billing Address
(if different from above): ____________________________________________
Phone Number:
___________________________ Email
Address: ________________________
LCWA Authorized
Signature: __________________________________ Date:
______________