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

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MEMBERSHIP INFORMATION:

Title:	First:	Middle or Maiden:	Last:
Mr. Mrs. Ms. Dr. Mr. & Mrs. Dr. & Mrs. Mr. & Dr. Dr. & Dr.
Spouse Title:	First:	Middle or Maiden:	Last:
Mr. Mrs. Ms. Dr. Mr. & Mrs. Dr. & Mrs. Mr. & Dr. Dr. & Dr.

Address:
City:	State:	Zip:

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

MEMBERSHIP LEVELS / PAYMENT METHOD:
(please make payments payable to: ULM L CLub)

Chief Warhawk: $125.00 Annually

Regular: $50.00 Annually

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

Check/Money Order

Bank Draft (include voided check)

ULM Payroll Deduction

Quarterly Installments

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Authorization Signature/Date

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