Associate Membership - Petroleum Club of Lafayette

Which Membership Are You Applying For?

Are you currently a member of the Petroleum Club of Lafayette?

If yes, what is your membership number:

Name of Applicant

Company

Position

Mailing Address

Apt, Suite, etc.

City

State

Zip

Email Address

Phone

Fax Number

Member Date of Birth

Social Security or Employer ID

Hobbies 1.

Hobbies 2.

Hobbies 3.

Spouse's Name

Spouse's Date of Birth

Wedding Anniversary

Children's Name & Dates of Birth

All Applications are submitted on the third Monday of each month for Board consideration