KNIGHTS OF NEMESIS

SOCIAL CLUB AND PARADE

P.O. BOX 291

ARABI, LA 70032

Web Site: www.nightsofnemisis.org

E-Mail: info@knightsofnemisis.org

2011/2012 MEMBER APPLICATION

NAME: ______________________________________________________________________________

ADDRESS: ____________________________________________________________________________

_____________________________________________________________________________________

HOME PHONE: _________________________________ WORK PHONE: __________________________

CELL PHONE: ___________________________________ PAGER: ________________________________

E-MAIL: ______________________________________________________________________________                        

NEWSLETTER DELIVERY PREFERENCE_______U.S. MAIL                  COSTUME SIZE: __________

                                                                        _______E-MAIL

Parade rider(s): __________

Dues:    (Please circle)

$225.00 Normal Payment

$ 150.00 Early Payment

Amount Paying: ______________

Float Lt. Name: ________________________________________________________________________

ญญญญญญญญญญญญญญญญญญ_____________________________________________________________________________________

KNIGHTS OF NEMESIS

SOCIAL CLUB AND PARADE

P.O. BOX 291       ARABI, LA 70032

Web Site: www.nightsofnemisis.org

E-Mail: info@knightsofnemisis.org

RECEIPT

RECEIVED FROM: _______________________________________________________________

AMOUNT RECEIVED: ________________________ DATE RECEIVED: ______________________

RECEIPT TYPE: _____________________________ RECEIVED BY: ________________________