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P O BOX 4463, SHREVEPORT, LA 71134 2009 Membership Application and Dues Remittance Date______________________________
PLEASE PRINT OR TYPE: Full Name_____________________________________________________________________ Name of additional family member in same household____________________________________ Address:______________________________________________________________________ City___________________________State_________________Zip +4 ____________________ Home Phone (_____)____________________ Work Phone (_____)_______________________ E-Mail address:________________________________________________________________ Family Surnames: (Four per member) 1._________________2_________________3__________________4___________________ 1._________________2_________________3__________________4___________________ Membership in ALTGA is from January 1 through December 31. Annual dues are $20.00 for an individual membership and $25.00 for a family membership. Dues for persons joining in last half of year (July 1 through December 31) are $10.00 for an individual membership and $12.50 for a family membership. Renewal membership dues are due by January 31at the 'whole year' rate . Each membership will receive the current quarterly issue of the Genie. Please complete and send your check with this application.
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