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
| 