ULM L CLub Membership Application

ULM L CLub
Anna Gray Noe Alumni Center
Monroe, LA 71209-9010

You have two options to complete this application:
1. PRINT this form, complete by hand and mail it to the above address
2. FILL OUT this form within your browser, print it, and mail it to the above address

MEMBERSHIP INFORMATION:

Title:	First:	Middle or Maiden:	Last:

Spouse Title:	First:	Middle or Maiden:	Last:

Address:

City:	State:	Zip:

Home Phone:	(	)	-
Work Phone:	(	)	-	ext.
Cell Phone:	(	)	-
E-mail:
Sport(s)/Year(s):

MEMBERSHIP LEVELS / PAYMENT METHOD:

Chief Warhawk:
$100.00 Annually

Regular:
$25.00 Annually

Lifetime: $600.00
Invested: Earnings pay for regular annual membership

Check/Money Order (Make payable to: ULM L Club)

Card Number:

Expiration Date:
(mm/yyyy)

Authorization Signature/Date

Your signature above authorizes the ULM L Club to process payment for membership.