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:
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