LJOA MEMBERSHIP APPLICATION 2010

NAME: __________________________________________

ADDRESS: __________________________________________

__________________________________________

AGENCY __________________________________________

AGENCY ADDRESS__________________________________________

__________________________________________

EMAIL ADDRESS ______________________@__________________

FEES FOR ACTIVE OR ASSOCIATE ARE………….. $ 20.00

PLEASE CHECK MEMBERSHIP TYPE YOU WISH TO JOIN:

ACTIVE________ ASSOCIATE _________ PAST PRESIDENT ______

**IF YOU ARE A PAST PRESIDENT PLEASE PROVIDE US WITH A CURRENT ADDRESS SO WE MAY KEEP IN TOUCH WITH YOU. **

ALL INFORMATION WILL BE KEPT CONDIENTIAL

Will you be attending this years conference YES NO (CIRCLE ONE)

PLEASE MAIL APPLICATION TO:

Louisiana juvenile Officer's Association
P.O. Box 461
Alexandria, LA. 71309
or fax application to (318) 448-5390

Also you may register at the conference.