|
TOGETHER
WE ARE STRONGER
COLAA Membership Application
____ New ____Renewal
Annual membership dues are:
___Individual ($15) ___Family ($20) ___Organization ($25)
Please list the contact information to be published in the Member Guide Directory:
____ New ____Renewal
Annual membership dues are:
___Individual ($15) ___Family ($20) ___Organization ($25)
Please list the contact information to be published in the Member Guide Directory:
NAME: _____________________________________________________________
ORGANIZATION: ____________________________________________________
ADDRESS: __________________________________________________________
CITY, STATE, ZIP: ____________________________________________________
EMAIL: _____________________________________________________________
HOME PHONE: ____________________________
WORK
PHONE: ____________________________
FAX NUMBER: _____________________________
CELL PHONE: ______________________________
Please make your check payable
to "COLAA" and mail to:
COLAA
P.O. Box 51648, Lafayette, LA. 70505-1648
|
|
|
|
HELP US HELP ANIMALS BY BECOMING A DUES-PAYING MEMBER!