If you have read our mission statement and wish to become a member, then

 

PLEASE PRINT OUT AND MAIL TO:

THE BATON ROUGE COUNCIL ON HUMAN RELATIONS

254 NELSON DRIVE, BATON ROUGE, LA 70808

MEMBERSHIP APPLICATION

 

Being in agreement with the principles of the Baton Rouge Council on Human Relations as set forth in its Statement of Purposes, I submit my applications for membership in the Council and enclose payment as follows:

 

( ) Single membership………………..$15.00

( ) Family membership……………….$20.00

( ) Student/low income membership.…$1.00

 

Date

 

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Name

 

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Street Address or Box Number

 

 

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City                                                                            State                                   Zip

 

 

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telephone

 

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email

 

 

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Signature