LOUISIANA CREOLE RESEARCH ASSOCIATION
MEMBERSHIP APPLICATION
To become an active or supporting member of Louisiana Creole Research Association, please fill out the following form, make checks payable to Louisiana Creole Research Association, and return to:
LA Creole
P. O. Box 3188
Slidell , LA 70459-3188
Name____________________________________________
Address______________________________________________
City ______________________ State________ Zip__________
Phone __________________ email _______________________
Additional Family members (if any)
________________________________________________
Membership Dues (annually):
___ |
Individual |
$30 |
___ |
Couple |
$40 |
___ |
Family |
$50 (up to 4 family members in same household |
___ |
Student |
$15 (full time) |
___ |
Group/Organization |
$100 (8 or more members) |
___ |
Corporate |
$200 |
Research Names: ____________________________________________________
_____________________________________________________
Committees - Please check any committees you may be interested in:
Membership ___ Program ___ Conference ___ Telephone ___ Grants ___
Reason for Joining:
Academia___ Genealogist___ Family Research___ Author___ General Interest ___ Historian__
How did you find out about La Creole?
______________________________________________________
- I give my permission to share my personal information (address, phone #, and/or email address) with LA Creole members.
- I do not wish to share my personal information with LA Creole members.
_________________________________________________
(signature) (date)
Do not write below this line
_________________________________________________
Amount received $_______ Check No. _________ Posted by________________ Date _____
Form 2-02/05
