To pay the $100 provisional fee (plus a $3 online surcharge), please click the ‘Pay Now’ button below. If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required. Full Name * Mailing Address * Phone Number Email * Date of Birth * Spouse's Name (if applicable) T-Shirt Size * Small Medium Large XL 2X Employer Work Phone Number Job Title How did you hear about the Junior League of Lynchburg? * Why are you interested in joining the Junior League of Lynchburg? * Currently, what community service activities do you perform? * What do you hope to accomplish in your first year in the Junior League of Lynchburg? * I certify that the above information is correct, and that the Junior League of Lynchburg may use my information to contact me regarding my application. * Date *
