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TOGETHER
WE ARE STRONGER
COLAA Membership Application
___ New ____Renewal
Annual membership dues are:
___Individual ($10) ___Family ($15) ___Organization ($25)
Please list the contact information to be published in the Member Guide Directory:
___ New ____Renewal
Annual membership dues are:
___Individual ($10) ___Family ($15) ___Organization ($25)
Please list the contact information to be published in the Member Guide Directory:
NAME:
_____________________________________________________________
ORGANIZATION: ____________________________________________________
ADDRESS: __________________________________________________________
CITY, STATE, ZIP: ____________________________________________________
EMAIL: _____________________________________________________________
HOME PHONE: ____________________________
WORK
PHONE: ____________________________
FAX NUMBER: _____________________________
CELL PHONE: ______________________________
Please make your check payable
to "COLAA" and mail to:
COLAA
P.O. Box 3636
Pineville, LA 71361-3636
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You
can support COLAA's work by becoming a dues-paying member.