Club Membership Registration Form

Louisiana Aggie Moms Club

Membership Application 2023-2024
HOWDY AGGIES MOMS!

This form contains required elements that help us prevent duplicate payments and submissions. In order to prevent issues, please make sure to carefully complete each section and field on the form. If you reach the bottom of the form and you do not see a "SUBMIT" button, then you are missing one of the required elements. If you must restart the form, its okay, but make sure your browser is complete closed and then restart the form from the Aggie Moms link.
Just oneI have two Aggies!My Aggies have graduated!
New MemberRenewalRing of Honor
College Station CampusGalveston Campus
MEMBER INFORMATION

Please complete the following information for the member (You).
Member Name:

First NameLast Name
Member Phone Number:

Area CodePhone Number
Member E-mail:
Member Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
AGGIE INFORMATION

Please complete the following information for the Aggie
Aggies Name:

First NameLast Name
Aggies Birth Date:

MonthDayYear
Aggie's Cell Number:
Please enter a valid phone number.Format: (000) 000-0000.
Aggie's Email:
example@example.com
Aggie's UIN:*
TAMU Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Aggie's Major:
Graduating Class Year:
AGGIE #2 INFORMATION

Please complete the following information for the Aggie
Aggie #2's Name:

First NameLast Name
Aggie #2's Birth Date:

MonthDayYear
Aggie #2's Cell Number:
Please enter a valid phone number.Format: (000) 000-0000.
Aggie #2's Email:
example@example.com
Aggie #2's UIN:*
Aggie #2's TAMU Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Aggie #2's Major:
Aggie #2's Graduating Class Year:
MEMBERSHIP DUES & DONATIONS

A Selection AND Quantity is required before you may submit payments.

Mom Yearly Dues (CS)

COLLEGE STATION

$25.00 Quantity

Mom Yearly Dues (G)

GALVESTON

$25.00 Quantity

Ring of Honor Mom

$10.00 Quantity

Student SPRING Goody Bag Donation

$25.00 Quantity

Student FALL Goody Bag Donation

$25.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

For questions or additional information, contact:

Martha Conly- Membership Chair
- (318)465-3810
- LAmomsMemb@aggiemoms.org
Cylinda Barron - President
- (985)290-7900
- LAmoms@aggiemoms.org
Shannon Self - Treasurer
- (318)470-5866
- LAmomsTreas@aggiemoms.org
Should be Empty:

Louisiana Aggie Moms Club

HOWDY AGGIES MOMS!

MEMBER INFORMATION

AGGIE INFORMATION

AGGIE #2 INFORMATION

MEMBERSHIP DUES & DONATIONS