If you have
read our mission statement and wish to become a member, then
PLEASE PRINT OUT AND MAIL TO:
THE BATON ROUGE COUNCIL ON HUMAN RELATIONS
254 NELSON DRIVE, BATON ROUGE, LA 70808
MEMBERSHIP APPLICATION
Being in agreement with the
principles of the Baton Rouge Council on Human Relations as set forth in its
Statement of Purposes, I submit my applications for membership in the Council
and enclose payment as follows:
( ) Single
membership………………..$15.00
( ) Family
membership……………….$20.00
( ) Student/low income
membership.…$1.00
Date
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Name
_____________________________________________________________________
Street Address or Box Number
_____________________________________________________________________
City State Zip
________________________________________
telephone
________________________________________
email
_______________________________________
Signature