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Reaching Out--Where are You?
INSTRUCTIONS: *Questions 1-9 must be answered to submit the form. You can type in "NA" if you do not want to submit a response to a question.
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* Indicates required question
LCS Membership ID
*
Your answer
1. First name:
*
Your answer
2. Last name:
*
Your answer
3. Are you planning to stay at Lakeside during this health crisis? Check only one
*
Yes
No
4. What is your location? Check only one In "Other" you can type in your location.
*
Ajijic
La Floresta
San Antonio
Chapala
San Juan Cosala
Other:
5. Phone number:
*
Your answer
6. Preferred email:
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Your answer
7. Name of local Emergency Contact:
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Your answer
8. Phone # of emergency contact:
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Your answer
9. Emergency contact Email:
*
Your answer
Comments:
Your answer
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