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Form should be printed, filled out,
and mailed to address on bottom
of form.
North
Louisiana Ballooning Association, Inc.
Membership
Form
2002-2003
Membership Dues are: $15 per year for an Individual, and
$25 per year for a Family.
The Membership Period is November 1 through October 31.
MEMBER INFORMATION:
LAST NAME: ___________________________________________
FIRST NAME: ___________________________DOB:________________
MAILING ADDRESS: ________________________________________
CITY, STATE, ZIP: ________________________________________
HOME PHONE: __________________ WORK PHONE: __________________
CELL PHONE: __________________ E-MAIL: ________________________
I AM: ___ PRIVATE PILOT ___ COMMERCIAL PILOT
___ STUDENT PILOT ___ CREW CHIEF
___ CREW MEMBER ___ ENTHUSIAST
For Family Membership, please list family members:
NAME: ____________________DOB:______ E-MAIL: _________________________
NAME: ____________________DOB:______ E-MAIL: _________________________
NAME: ____________________DOB:______ E-MAIL: _________________________
NAME: ____________________DOB:______ E-MAIL: _________________________
NAME: ____________________DOB:______ E-MAIL: _________________________
Please make checks payable to: NORTH LOUISIANA BALLOONING ASSOCIATION, INC.
Return this form and check to: NORTH LOUISIANA BALLOONING ASSOCIATION, INC.