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Club Name: ____________________ Team Name: _______________________
Contact Name: ____________________________________________________
Address: _________________________________________________________
City: ____________________________ State: ______ Zip: _______________
Phone: __________________________ Fax: ____________________________
Club Officers: _____________________________________________________
_______________________________________________________________
Include $50 membership fee. All memberships expire Dec. 31.
Payment and/or this application can be mailed to:
Shane Hernandez
ATTN: LAMBRA
1304 Bertrand Drive Suite A6
Lafayette, LA 70506
Make checks payable to: LAMBRA
Download the Adobe Acrobat version of this application.
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