SWLGS MEMBERSHIP APPLICATION



Dues (Jan. - Dec.) $12 Individual
                               $17 Family (Husband /Wife)
                               $22 Patron (Individual or Husband/Wife)

NAME(S)______________________	___________________________________	________________
First	Middle/Maiden	Last

ADDRESS________________________________________________________________________

____________________________________	________________________________	_____________
City	Parish/County	State Zip + 4

Phone: _________________________ Email: ___________________________________________


Have you been a member of this Society before? ____________


Please print this form. Send it and your dues to:
                                             SWLGS
                                             P.O. Box 5652
                                             Lake Charles, LA 70606-5652

                              For any questions or comments please contact: Pat Huffaker