Southern California LSU Alumni

Membership Form for Check Payments

 

Please print and mail with your check for $20 to:
Southern California LSU Alumni Association
c/o Ham Homan
47 Pamela Way
Cota de Caza, CA 92679

If you'd rather pay by credit card, click here.

Name___________________________________________________________________

Address________________________________________________________________

City, State, Zip_______________________________________________________

Home Phone__________________________Work Phone_________________________

Email Address__________________________________________________________

Company Name or Occupation_____________________________________________

Year Graduated and Degree______________________________________________  
Chapter Dues $20_____________________Date Paid___________________

$10 of the dues goes to scholarships!      

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