Prepaid | Krewe of Black & Gold

Prepaid or gifted membership(s)

Please complete this information if you have submitted your Founding Membership donation(s) at a special event or directly to a Krewe of Black & Gold representative, or if you were gifted a membership.

Date of event/prepayment *

If your membership was gifted, please provide approximate date.

Event/meeting (if applicable)

If your membership was gifted, please leave this line blank.

Your name as you wish it listed in the member directory *

First

Last

Payment method *

Cash
Check
Paypal/credit card
Gifted membership

If you have prepaid for your membership at an event, please select your payment method utilized. If gifted a membership, please check the "gifted" box.

Total amount of payment submitted (in dollars only, no symbols) - 25/Founding Member, 50/VIP Founding Member *

Krewe of Black & Gold representative to whom payment was submitted (if applicable)

If your membership was gifted, leave this line blank.

Please confirm that you have received your donation gift(s) *

Received
Not received

If you have received a gifted membership, your member gifts have been provided to or shipped to the address provided by the gifter.

Name on check or credit card payment, if different than name indicated above

First

Last

If your membership was gifted, please indicate the name of the gifter.

Your email *

Phone (will only be utilized if there is a question about this information)

Please indicate if this includes gift(s)

Gifted membership/donation(s)

PLEASE INDICATE WHICH MEMBERSHIPS WERE SELECTED/PREPAID/GIFTED

To add member(s) names and optional dedication(s) to the online Spirit of Louisiana pages, please add that information where indicated below. Maximum of four Founding Members and four VIP Founding Members per form. For larger quantities, please contact us. If your membership was gifted, please select individual membership level received.

Krewe of Black & Gold Founding Memberships

One membership - $25.00
Two memberships - $50.00
Three memberships - $75.00
Four memberships - $100.00

Krewe of Black & Gold VIP Founding Memberships

One VIP membership - $50.00
Two VIP memberships - $100.00
Three VIP memberships - $150.00
Four VIP memberships - $200.00

MEMBER NAMES AND DEDICATIONS

Please select the prepaid membership option(s) in the above section to activate member name and dedication fields.

For gifted submissions, you are verifying that you are authorized to include your recipients' names and/or dedications in the online directory. To allow your gift recipients to complete their own member directory and/or dedication listings, please list donor's name from line one of this form and "TBD" in appropriate fields. Instructions for their personalizations will be included on the gift certificates available following checkout.

MEMBER NAMES: Please list member names exactly as desired to be listed in the online member directory. If no online listing is desired please mark the spaces "N/A." Maximum 40 characters.

DEDICATIONS: Please mark space "N/A" if no dedication is desired. Dedications should indicate whether "In memory of" or "In honor of" and from whom the dedication is presented, i.e. "In loving memory of John Smith from Jane Smith" or "In honor of General Hospital ICU Staff from the Smith family." Be sure to include your signature exactly how you wish it included on the dedication page (See examples above.) 125 character max.

FOUNDING MEMBERS

First Founding Member's Name *

First

Last

First dedication and signature name

Second Founding Member's Name *

First

Last

Second dedication and signature name

Third Founding Member's Name *

First

Last

Third dedication and signature name

Fourth Founding Member's Name *

First

Last

Fourth dedication and signature name

VIP FOUNDING MEMBERS

First VIP Founding Member's Name *

First

Last

First VIP dedication and signature name

Second VIP Founding Member's Name *

First

Last

Second VIP dedication and signature name

Third VIP Founding Member's Name *

First

Last

Third VIP dedication and signature name

Fourth VIP Founding Member's Name *

First

Last

Fourth VIP dedication and signature name

SPONSORSHIP OPPORTUNITIES

If you would like to receive information about the Spirit of Louisiana Jazz Funeral and Second Line sponsorship opportunities, please provide contact name and email address as indicated. Sponsorship levels begin at $500.

Potential sponsor contact name

Potential sponsor contact email

Prepaid Memberships

Prepaid or gifted membership(s)

PLEASE INDICATE WHICH MEMBERSHIPS WERE SELECTED/PREPAID/GIFTED

MEMBER NAMES AND DEDICATIONS

FOUNDING MEMBERS

VIP FOUNDING MEMBERS

SPONSORSHIP OPPORTUNITIES

Thank you for your support!