From: Subject: Membership Application Date: Tue, 6 Oct 2009 23:35:12 -0500 MIME-Version: 1.0 Content-Type: text/html; charset="utf-8" Content-Transfer-Encoding: quoted-printable Content-Location: https://webaccess.dss.state.la.us/gw/webacc/952d961c214d7a9995981b1556fe2c52d234f088/GWAP/AREF/1?action=Attachment.View&error=fileview&Item.Attachment.filename=Membership+Application%2e2009+Frames%2edoc&Item.Attachment.id=1&User.context=952d961c214d7a9995981b1556fe2c52d234f088&Item.drn=96144z1z88861&Item.Child.id=&Item.Attachment.allowViewNative=1 X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 =EF=BB=BF Membership = Application

LCHSS Membership = Application=20   
 

Please enroll me as a member or renew my = membership=20 in the Louisiana Conference of Health and Social Services (LCHSS) = beginning the=20 Month of _______________________. 
 

Enclosed is my check = for: 

____ $15 New Membership

____ $13 Renewals

____ $ 7 Retirees and Students=20  
 

Please make checks payable to:

LCHSS

P.O. Box 706

Port Barre, LA=20 70577  
 

Name:     =20 ___________________________________________________ 

Address:  =20 ___________________________________________________

 

City & Zip:=20 ___________________________________________________ 

Work E-Mail (Optional):=20 _________________________________________ 

Personal E-Mail (Optional): =20 ______________________________________ 

LCHSS Region:=20 ______________________________________________  <= /FONT>