Please print and mail to address below

Louisiana Landowners Association, Inc.

Membership Application and Annual Dues Schedule

Company ______________________________________________

Name _________________________________________________

Address _______________________________________________

City ________________________________________

State ____________ Zip Code ___________________

Phone (_____) ____________________

FAX (______) ____________________

E-Mail: ___________________________________________________

Please Choose one

/__/ Regular Membership:
Number of acres owned/managed ___________ X 12¢ per acre = $ ___________
(minimum annual membership dues: $60; maximum annual membership dues: $6,100)

/__/ Associate Membership                                 Fee   $250.00

___ Check Enclosed    ____ Send Invoice

Please Make Checks payable to:

Louisiana Landowners Association, Inc.
8982 Darby Avenue
Baton Rouge, Louisiana  70806

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