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CANE RIVER COMMUNITY OF ISLE BREVELLE, LOUISIANA

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St. Augustine Historical Society
MEMBERSHIP APPLICATION FORM
for 2002 Membership


NOTE: Annual membership is $10/person.
Membership period is January 1 - December 31
NEW MEMBERS WILL BE ACCEPTED ANYTIME!!
Please complete a form for each person applying for membership:

This form should be printed, completed and mailed to S.A.H.S. -P. O. Box 39, Melrose, Louisiana 71452
Make all checks payable to St. Augustine Historical Society - Memberships are tax deductible.

*****************************************************************************************

Name: _________________________________________________________________

Address: ______________________________________________________________

City: _________________________________ State__________  Zip __________

Telephone No. _________________________________________________________
               (include area code)

______ Check here if you would like your name included in the Membership Directory.
_______ Enclosed is a donation of $ ______________
******************************************************************************************

Name: _________________________________________________________________

Address: ______________________________________________________________

City: _________________________________ State__________  Zip __________

Telephone No. _________________________________________________________
               (include area code)

______ Check here if you would like your name included in the Membership Directory.
_______ Enclosed is a donation of $ ______________
******************************************************************************************

Name: _________________________________________________________________

Address: ______________________________________________________________

City: _________________________________ State__________  Zip __________

Telephone No. _________________________________________________________
               (include area code)

______ Check here if you would like your name included in the Membership Directory.
_______ Enclosed is a donation of $ ______________
******************************************************************************************

CONTACT PHONE: 318/357-0602



St. Augustine Historical Society
P. O. Box 39 Melrose, LA 71456
(318)357-0602
webmaster: colsonj@cp-tel.net

Copyright 1998-2000 St. Augustine Historical Society. All Rights Reserved. St. Augustine Historical Society. All Rights Reserved. St. Augustine Historical Society. All Rights Reserved.