Louisiana Creole Research Association

2007 MEMBERSHIP RENEWAL APPLICATION

 

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(s)_______________________________________________

_______________________________________________

Address (current)______________________________________

City ______________________ State________ Zip__________

Phone __________________ cell phone __________________ email_________________

Profession/Occupation__________________________ Retired? yes___ no___

Family Names currently researching:

___________________________________________

__________________________________________________________________________

Membership Dues (annually)—please check the appropriate category:

___	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

 

Please check a committee you would like to serve on:

  ____Membership ____Program ____Conference

____Telephone ____Financial ____Publicity

   

_______________________________________ ________________
(signature) (date)

 

Do not write below this line ______________________________________________________________________

Amount received $_______ Check No. ________ Posted by ____________ Date _________

Form 2-02/05