C. G. JUNG SOCIETY OF LAFAYETTE, LOUISIANA
                                                            
Website: cgjunglafayettela.org

                                                                 Email: cgjungsocietylafayettela@cox.net

                                            Phone:  (337) 232-9914




 
                                                                                        MEMBERSHIP
                                       September 2019 – August 2020



                       CHECK PAYMENT(S):                                                                 CHECK ONE:

                       □  $100.00   -  Benefactor                                                                □  New
                       □   $50.00    -  Individual                                                                 □ Renewal
                       □   $25.00    -  Senior (65+)    
                       □   $25.00    -  Student/Faculty (with ID)                         
                       □  $_____    -  Donation                                                                                             
              

            
         NAME:                                                                 DATE:                                        


             ADDRESS:                                                                                                                                          
                                       

                                                                                                                                                                                                
                                         
            PHONE:                                                                                                 


            E-MAIL:                                                                                                   
                             □  “Check Here to Receive Email Announcements & Updates”

             AMOUNT ENCLOSED:                                               CHECK NO.                                                                                     

           
             

         MAIL CHECK  WITH COMPLETED FORM TO:
                   C. G. Jung Society of Lafayette, LA

               Attn:  Membership
               P.O. Box 683
               Abbeville, LA  70511


             OR

             PAY ONLINE WITH CREDIT/DEBIT CARD AT:
             https://www.cgjunglafayettela.org 
        

 

 
         


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C.G. Jung Society of Lafayette, LA

All Rights Reserved