Date:______________________________

Name:____________________________________

Address:_________________________________________________________

Home Phone: ____________________Mobile Phone:_____________________

Occupation:____________________________ Mail preference: Home___ Business___

Firm Name:__________________________________

Address:_________________________________________________________

Phone:___________________________

Email:_______________________________________

I agree to pay such fees and assessments as may be required for my membership as indicated below:

Embroidered Krewe vest (approximately $100.00)

$200.00 annual dues (one person)

$100.00 additional person (significant other)

(Note: Our fiscal year runs from January 1^st to December 31^st. Dues follow our fiscal year.)

Sponsored for membership by:

Signature of Applicant:

We thank you in advance for your interest in our Krewe. Someone from our membership committee will be contacting you.