Vermilion Parish Sheriff Eddie Langlinais

IN SUPPORT OF SHERIFF EDDIE LANGLINAIS

MEMBERSHIP APPLICATION

FULL NAME

SPOUSE'S NAME (If Joint Membership)

MAILING ADDRESS

CITY

STATE

ZIP CODE

PHONE

SPOUSE'S PHONE (If Joint Membership)

EMAIL ADDRESS

SPOUSE'S EMAIL ADDRESS (If Joint Membership)

SHIRT SIZE

SPOUSE'S SHIRT SIZE (If Joint Membership)

User Agreement

The above information is true and correct, and I hereby authorize the Campaign of Eddie Langlinais and/or it’s agents to make an independent investigation of my background, references, character, criminal or police records, including those maintained by both public and private organizations, and all public records for the purpose of confirming the information contained on this application and/or obtaining other information that may be material to my qualifications now, or, if applicable, during the tenure of my membership. By signing this document, I release the Campaign of Eddie Langlinais Organization from any liability for an opinion(s) it may form or any decision it might make regarding my qualifications to be a member of the Vermilion 300.

PLEASE TYPE YOU ELECTRONIC SIGNATURE(S) BELOW

SIGNATURE

SPOUSE'S SIGNATURE (If Joint Membership)

DATE

AFTER CLICKING THE 'SUBMIT' BUTTON YOU WILL BE TAKEN TO ANOTHER PAGE. PLEASE CLINK THE 'JOIN NOW' BUTTON THERE TO PROCEED TO ONLINE PAYMENT