Toledo Bend
Bi-State
Alliance

Associate Membership Application

Toledo Bend Bi-State Alliance

Join the Alliance online

Name

Email

Address

City

State

Zip Code

Phone

(000) 000-0000

Comments: Please let us know your interests, concerns, and areas of expertise

NOTE: This is an application for membership. All applications for membership are subject to acceptance by the organization. If, for any reason, your membership is not accepted, you will be notified and your funds will be returned.

Associate Membership in the Toledo Bend Bi-State Alliance is $10.00 per year for an individual or $15.00 for the family. We will Email you an invoice and you may pay by personal check or money order mailed to the address below. Please be certain to identify yourself - a printed copy of this form sent with your check would be appreciated. Send your membership dues in the amount of $10.00 or $15.00 to:

	Janna Lehman 195 Sassafras Drive Hemphill, Tx. 75948 (409) 625-3394