LAMBRA MEMBERSHIP FORM

Club Name: ____________________ Team Name: _______________________ Contact Name: ____________________________________________________ Address: _________________________________________________________ City: ____________________________ State: ______ Zip: _______________ Phone: __________________________ Fax: ____________________________ Club Officers: _____________________________________________________ _______________________________________________________________ Include $100 membership fee. All memberships expire Dec. 31. Payment and/or this application can be sent to the LAMBRA Treasurer: