Mr. ( ) Miss () Mrs. ( ) Dr. ( ) Ms ( ) _______________________________________________________________________________ First Name Middle Last Name _______________________________________________________________________________ Home Address: Street City State Zip Code _______________________________________________________________________________ Mailing address (if different) If a business/institution, please give name _______________________ _________________________ ___________________ Home Phone Office Phone email address Are there any of the following areas in which you would like to volunteer? Contribute articles for Chronicle ____ Serve on Board ____ Research ____ Membership ____ Plan Meeting Programs ____ Plan field trips ____ Other (please explain): __________________________________________________________________________________ Complete form and return with dues to: 
Treasurer, The Laffite Society 
P O Box 1325 
Galveston, TX 77553
Membership Classification and Dues (circle one) : Student $15.00 - Individual $30.00 - Senior Citizen (Over 65) $15.00 - Family $35.00 Institution $15.00 - Sustaining Member $100 - Life Member $350.00 (one payment)

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