Patron Membership | Urban League of Louisiana

URBAN LEAGUE OF LOUISIANA PATRON MEMBERSHIP

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Date:

CONTACT INFORMATION

Name

First Name

Last Name

Title/Position

Primary Mailing Address

City

State

Zip

Country

Phone

PROCESSING YOUR MEMBERSHIP DUES

Item	Qty	Total
Patron Membership	1	250.00

Annual Charge $xxx

Once you hit submit you will be taken to the PayPal website to complete your membership payment. Thank you!