Toledo Bend
Bi-State
Alliance

Organization Membership Application

Toledo Bend Bi-State Alliance

Join the Alliance online

Organization Membership Form

Organization Name

Approximate Membership

Delegate
Name

Delegate
Email

Delegate Address

Delegate
City

Delegate
State

Delegate
Zip Code

Delegate
Phone

(000) 000-0000

Alternate
Name

Alternate
EMail

Alternate
Phone

(000) 000-0000

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

Organization Membership in the Toledo Bend Bi-State Alliance is $25.00 per year. We will Email you an invoice and you may pay by personal check or money order mailed to either of the addresses 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 $25.00 to:

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