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Thank you for choosing to become a Liveable City !
Please complete this form to complete your membership. Fields marked
*
are
required
for proper processing of your payment. Note: this is a
LIVE
transaction form. When you submit your payment, it will be processed immediately.
If you include your email address below, you will receive a confirmation of the transaction, otherwise no electronic confirmation will be sent
.
Name on Card
*
Card Number
*
(no spaces or hyphens)
Expiration Date
*
(mm/yy)
Amount of donation:
$.00
Verification number
*
This is the last three digits of the number on the back of your card.
Billing Information
Please note: to be a voting member you must be a resident of and/or have your primary employment in Travis, Williamson, Hays, Bastrop or Caldwell County.
Company
Address Line 1
*
(where you receive your statements)
Address Line 2
City
State
Zip
*
Phone
*
Fax
E-mail
*
Your confirmation will go to this address. If one is not provided, you will not receive electronic confirmation of this donation.
