Copyright © 2015-2017

C.G. Jung Society of Lafayette, LA

All Rights Reserved


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

                                                                 Email: cgjungsocietylafayettela@cox.net

                                            Phone:  (337) 232-9914




 
                                                                                        MEMBERSHIP
                                       September 2017 – August 2018



                       CHECK ONE:                                                                                CHECK ONE:  

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


             ADDRESS:                                                                                                                                          
                                       

                                                                                                                                                                                                
                                         
            PHONE:                                                                                                 


            E-MAIL:                                                                                                   
                             □  “Check Here to Receive Email 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 VIA PAYPAL AT:
                   https://www.cgjunglafayettela.org/membership.html