Annual Meeting Registration

Annual Meeting Registration
Wednesday, March 18th | Register by Friday, March 13th
Robicheaux Recreation Center 1919 Eraste Landry Rd.
Name

First NameLast Name
Last 4 of Social Security Number
Meal

YesNo
Name

First NameLast Name
Last 4 of Social Security Number
Meal

YesNo
Name

First NameLast Name
Last 4 of Social Security Number
Meal

YesNo
Name

First NameLast Name
Last 4 of Social Security Number
Meal

YesNo
Total eating
x $10
Total Due
Member Number*
Withdraw the total due from my Maple Account.

YesNo
Account*

CheckingSavings
Withdraw from account number*
Should be Empty: