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Individual Membership Form

Email *

Full Name *

Address

City

State/Province

ZIP

Country

Tel

Fax

Were you Recommended by a LCJE Member? If so, who?

First Recommendation

Second Recommendation

Please indicate your agreement with the following:

1
The Lausanne Covenant

2
The aims of the LCJE

3
Upon acceptance of my application I will comply with the dues requirement (US $25)

Security Code: *
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