LAMPPAC
DUES, $50.00 PER CALENDAR YEAR, PER AGENCY

DOWNLOAD, PRINT AND MAIL THIS FORM ALONG WITH YOUR PAYMENT TO:

Wilfred Cochico
Purchasing Officer/LAMPPAC Treasurer
City of Lakewood
5050 Clark Ave. Lakewood, CA 90712
Email: wcochico@lakewoodcity.org

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First Name
Last Name

Title

Certification of purchasing official :

CPPOCPPB CPM OTHER

Agency Name

Address - line 1

Address - line 2

City

State Zip Code
Internet E-Mail
Telephone No.Fax Number

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