Louisiana Alliance for the Preservation of Cultural and Rural Lifestyles

Association membership categories are as follows:
(a) Certified Resident Louisiana Citizen Members.
(b) Certified Associate Members.
(c) Certified Businesses, Vendors, and Contractors
(d) Certified Associations, Corporations, and Entities.

2008 MEMBERSHIP APPLICATION

Name ________________________________________________________  Date ___________

Assoc./Org./Entity______________________________________________________________

Physical Address _______________________________________________________________

City  __________________________________________  State _________ Zip _____________

Mailing Address ________________________________________________________________

City  __________________________________________  State _________ Zip _____________

E-Mail ________________________________________   Fax ______-______-_____________

Cellular Phone  ______-______-____________   Home Phone  ______-______-_____________

Driver's License #  ___________________________   State _____  DOB  __________________

Cultural and Traditional Areas Of Interest: ___________________________________________

______________________________________________________________________________

Membership dues are $60.00 annually due January 1st and payable to LAPCRL
Please complete application (print or type) and mail to:

LAPCRL
P. O. Box 880
Abbeville, LA 70511-0880

For questions call (337) 230-8881 or E-Mail lapcrl@lapcrl.org

- - - - - - - - - - - - - - - - - - -OFFICE USE ONLY - - - - - - - - - - - - - - - - - - - -

Payment Received:  Check: __________ Money Order: __________ Cash: __________
Membership Number:  _________________     Membership Category:  ____________