Application for NLAS Membership

Please print and mail with your check:

(circle one) Mr. Mrs. Miss Ms. Dr. Rev.

Name:  _________________________________________________

Mailing address :
_________________________________________________

_________________________________________________

City, State, Zip:
_________________________________________________

Home phone: 
_________________________________________________

FAX: 
_________________________________________________

Email address:
_________________________________________________


Please send me the Lutheran Scouter by the following method (choose one)

____  Email Notice            ____  Surface Mail

Name of home congregation:
_________________________________________________
ELCA or LCMS member or Other: _________________________________________________
Name of youth agency where registered: _________________________________________________
Name of Local Association (if known):  _________________________________________________

Level of membership which is being applied for (circle one)

Basic: $12.00
Couples:  $18.00
Contributor:  $50.00
Century Club:  $100.00
Life member:  $350.00

Enclosed is a check or money order for $ _____________

Mail to: 

National Lutheran Association of Scouters
8520 MacKenzie Road
St. Louis, MO 63123-3433

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Updated 8/16/2001