Lifetime Membership Application (79 and under)

Lifetime Membership Fee: $600.00

Please fill out and submit the form below. Although it is not required to provide a phone number, if you choose to include a phone number with your application please submit your phone number without dashes, spaces or parenthesis (9999999999 format). You will be redirected to PayPal for dues payment upon submission. If you are not redirected to PayPal or experience an error message from PayPal, please use Google Chrome or Firefox web browser to complete the form. If you require further assistance, please contact the state office at 225-927-8837 or info@lrta.net.

Lifetime Membership Application

Name *

First

Name *

Last

Address *

Street Address

Address 2

Address Line 2

City *

City

State *

State / Province / Region

Postal Code *

Postal / Zip Code

Country *

Country

Phone Number (please submit your phone number without spaces, dashes or parenthesis)

Email (by including your email you are automatically placed in the LRTA Email Club) *

How would you like to receive the LRTA Newsletter? (Select one) *

Please check here if you were referred by an AMBA Agent or received information from AMBA to join LRTA.

I was referred by an AMBA agent or I received information from AMBA to join LRTA.

Once you click submit, you will be redirected to PayPal to complete your payment information. If you have any problems, or questions, please call LRTA at 1-888-531-1992 or (225) 927-8837 during normal business hours.

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