Join the Krewe Please enable JavaScript in your browser to complete this form.Donor's Name *FirstLastEmail *PhoneMailing address to which donor gifts should be sent *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease indicate if this includes gift(s)Gifted membership/donation(s)MEMBERSHIP OPTIONSFor multiple submissions on a single form, all member gifts will be mailed to the mailing address indicated above. If multiple shipping options are desired, a separate form should be submitted for each shipping address desired. 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. Please complete this information prior to submitting payment. Krewe of Black & Gold Founding MembershipsOne membership - $ 25.00Two memberships - $ 50.00Three memberships - $ 75.00Four memberships - $ 100.00Krewe of Black & Gold VIP Founding MembershipsOne VIP membership - $ 50.00Two VIP memberships - $ 100.00Three VIP memberships - $ 150.00Four VIP memberships - $ 200.00Other (donation to support event without membership - please indicate donation amount)SPONSORSHIP OPPORTUNITIESIf 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 $500.Contact nameEmailMEMBER NAMES AND DEDICATIONSFor gifted submissions, you are verifying that you are authorized to include your recipients' names and/or dedications in the online directory. To allow your gift recipients to complete their own member directory and/or dedication listings, please list donor's name from line one of this form and "TBD" in appropriate fields. Instructions for their personalizations will be included on the gift certificates available following checkout. MEMBER NAMES: Please list member names exactly as desired to be listed in the online member directory. If no online listing is desired please leave the space empty. Maximum 40 characters. DEDICATIONS: Please leave blank if no dedication is desired. Dedications should indicate whether "In memory of" or "In honor of" and from whom the dedication is presented, i.e. "In loving memory of John Smith from Jane Smith" or "In honor of General Hospital ICU Staff from the Smith family." 100 character max. FOUNDING MEMBERSFirst Founding Member's Name *FirstLastFirst DedicationSecond Founding Member's Name *FirstLastSecond DedicationThird Founding Member's Name *FirstLastThird DedicationFourth Founding Member's Name *FirstLastFourth DedicationVIP FOUNDING MEMBERSFirst VIP Founding Member's Name *FirstLastFirst VIP DedicationSecond VIP Founding Member's Name *FirstLastSecond VIP DedicationThird VIP Founding Member's Name *FirstLastThird VIP DedicationFourth VIP Founding Member's Name *FirstLastFourth VIP DedicationPAYMENT SUBMISSIONTotal *$ 0.00Please review your selections and total, and complete members' information and dedications prior to submitting payment. Clicking the SUBMIT link will open the payment window on PayPal's secure payment website. Custom Captcha * = SUBMIT