SWLGS MEMBERSHIP APPLICATION




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


NAME (S)   _______________________________________________________________________________

                   First                                              Middle                                                  Last
ADDRESS________________________________________________________________________

_________________________________________________________________________________
City
Parish/CountyState 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