2006 LULAC Council Member Roster Form

Council Number_______________________________  EIN Number ___________________________________

 

National

Name

Home Address

City

State

Zip

HomePhone

WorkPhone

Fax

Email

Member Since*

Initiation Fee**

Annual Dues

1.                      
2.                      
3.                      
4.                      
5.                      
6.                      
7.                      
8.                      
9.                      
10.                      

Note: Type or print all information for each member. Home address for each member with city, state and zip code are required. Identify the Officers: P-President, VP-Vice President, etc. Annual National Dues are $12.00 per member. ** All new members or those not in good standing for the previous year pay a $4.00 initiation fee or pay back dues for the previous year. State and District Dues are paid to the State and/or District Directors. All charter/membership dues and the current roster are due on January 1 and must be received in the LULAC National Office by March 31. * Enter the year the member joined LULAC in the “Member Since” column. Make as many copies as are necessary to list all council members.

Subtotal

 

Annual Charter

 $50.00

Total Dues

 

LULAC  l  2000 L Street, NW, Suite 610  l  Washington, DC 20036  l  (202) 833-6130  Fax: (202) 833-6135