Membership Application

Title

First name*

MI

Last name*

Date of birth

Under 35?

Parish

Email address*

Phone number

Address*

Address 2 (Optional)

City*

State*

Postal Code*

Country

Spouse is joining concurrently with applicant named above (Additional fee of $11.75 will be applied)

Spouse is already a Serran (fill out NAME only)

First name

Last name

Date of birth

Email address

Phone number

Email address

Phone number

New Member Fee: ($11.75 per person)*

$

Credit Card Number

Expiration Date

I have included $11.75 for each new member indicated on this application.

(*) Denotes required fields