| Name | ||||||
| *Address | ||||||
| *City | *State | *Zip | ||||
| *Phone | *Work | |||||
| *Cell | *Pager | |||||
| *Shirt Size | ||||||
| *Newsletter | U.S. Mail | |||||
| Please check one | ||||||
| Social Member (Dues $50) Amount Paying | ||||||
| Parade Member (Dues $225) Amount Paying | ||||||
Mail this completed application along with a check to :
Knights of Nemesis Social Club and Parade
P.O. Box 291
Arabi, LA 70032
* Not required if you are a current social club member unless there is a change