Membership Form

Name: __________________________________________

Address: ________________________________________

City/ST/ZIP: _____________________________________

Phone: __________________________________________

Email: ___________________________________________

Membership Type (Individual or Corporate): ____________
(Please include check or cash....$25 for indiv/$100 for Corp.)

Particular Interests (i.e. Urban Planning, housing, environmental issues)

_________________________________________________

_________________________________________________

_________________________________________________

Please email this form to jessielagasse@smartgrowthla.org OR print it out and mail it with your payment to:

Smart Growth for Louisiana
533 Esplanade Ave Ste. B
New Orleans, LA 70116

FYI: If you choose to email your form, your membership will not become active until we receive your membership dues.

Thanks and welcome to Smart Growth for Louisiana!!!!!!!!!