Please complete this form and choose one of the following options:

1. Click the submit button -OR-
2. Print the form and fax it to (804) 346-8850, -OR-
3. Print this form and mail it to:
   Club Land’or
   4050 Innslake Drive, Suite 204
   Glen Allen, VA 23060

*Required Fields

 

Member #: * Name: * Address: * City: * State: Alaska Alabama Arkansas Arizona California Colorado Connecticut Washington, D.C. Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia VI U.S. Virgin Islands Washington Wisconsin West Virginia Wyoming * ZIP: * Country: Telephone: * (xxx) xxx-xxxx Fax: E-mail:   Signature (if mailing or faxing) _________________________ Date: _____________ If paying by credit card, please submit this completed form and call 800-552-2839 to complete payment.     I will be mailing a check (payable to Club Land'or)