Join the Krewe Please enable JavaScript in your browser to complete this form.Payor's Name *FirstLastPayor's Email *Phone (will only be used if there is a problem processing membership)Mailing address to which donor gifts should be sent *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeIf you are making a donation only without gifts to be shipped, please mark all address fields n/a. Please indicate if this includes gift(s)Gifted membership/donation(s)IMPORTANT: Membership gift optionsPlease mail my gifts. I understand they may not arrive prior to the event.I am planning to attend and will pick up gifts at the event. (ID required)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)If you wish to support this event without a membership, your donation is greatly appreciated. Please indicate amount of donation. Minimum Price: $10.00MEMBER 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 mark the spaces "N/A." Maximum 40 characters. DEDICATIONS: Please mark spaces "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." 100 character max. FOUNDING MEMBERSFirst Founding Member's Name *FirstLastFirst dedication and signature name *i.e. "In honor of all the volunteers who came to assist in the rebuilding of our commiunity - Jane Smith If you don't want to list a dedication, please mark N/A.Second Founding Member's Name *FirstLastSecond dedication and signature name *Third Founding Member's Name *FirstLastThird dedication and signature name *Fourth Founding Member's Name *FirstLastFourth dedication and signature name *VIP FOUNDING MEMBERSFirst VIP Founding Member's Name *FirstLastFirst VIP dedication and signature name *i.e. "In honor of all the volunteers who came to assist in the rebuilding of our commiunity - Jane Smith If you don't want to list a dedication, please mark N/A.Second VIP Founding Member's Name *FirstLastSecond VIP dedication and signature name *Third VIP Founding Member's Name *FirstLastThird VIP dedication and signature name *Fourth VIP Founding Member's Name *FirstLastFourth VIP dedication and signature name *PAYMENT 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 for payment submission via PayPal or credit card. If the PayPal link does not activate, please review your form to ensure all required fields have been completed.Custom Captcha * = PayPal Commerce *Click the PayPal link to pay via PayPal or credit card. SUBMIT