Thaddeus Hill, President
Regina Weyn, 1st Vice President
Shushanna Bacquie, 2nd. Vice President
Bernard Hawkins, Treasurer
Linda Schulz, Secretary
January 2005
LIFY
Dues & Committee Membership Form
Agency: _____________________________________________________________________
Adress: _____________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Telephone: ________________________________ Fax: ____________________
Check
level of Membership:
Individual Membership $25.00
Agencies with a budget of 1 Million and under $50.00
Agencies with a budget of 1 Million to 5 Million $100.00
Agencies with a budget of 5 Million & above $150.00
Public Agencies $ 100.00
Please make your check out to " LIFY".
Mail check to: Berkshire Farm Center and Services for Youth
Attn: Bernard Hawkins
560 Broad Hollow Road, Suite 208
Melville, New York 11747
Please help in doing the work necessary by joining one of LIFY's committees. Next to the selected committee, please indicate your name or the names of any member of your staff that would be willing to participate.
Legislative:
____________________________________________________________
Conference/Training:
_________________________________________________________
Community Relations:
_________________________________________________________
Outreach:
_____________________________________________________________
Nominating:
____________________________________________________________
We thank you and salute you!