GCLA
MEMBERSHIP APPLICATION
NAME:
____________________________________________________
ADDRESS: __________________________________________________
COUNTY: ___________________________________________________
PHONE:
__________________________________________________
TEAM/CLUB:
_________________________________________________
E-MAIL
ADDRESS:
____________________________________________
TYPE
OF MEMBERSHIP:
$15.00 FULL MEMBERSHIP
(Must have been an instructor for at least 1
year and must reside in the state of
$10.00 AFFILIATE
FULL MEMBERSHIP RENEWAL
AFFILIATE RENEWAL
NEW MEMBER (NEED BADGE $5.00 EXTRA)
I
have _____ years of teaching experience.
I
have teaching experience in the following venues:
Please
mail this application with your dues, payable to GCLA, to:
JEANNIE MOBLEY
1870 MACK ROAD
DOUGLASVILLE, GA 30135
770-942-9896