Affiliate Application

The Louisiana Wildlife Federation (LWF) requires the following information in order to communicate effectively with its affiliates. Please complete all the requested information on this form for our records. LWF mainly communicates by email to reduce cost and paper, but may periodically send info through the mail.

Renewal Deadline: Completed form must be received and dues paid by January 31st.

If you prefer print and mail the application form, you may download it here.

Affiliate Dues: $125

You will be redirected to the Donation page after submission to pay your dues.

Step 1 of 3

Date
MM slash DD slash YYYY
Name of Organization*
Organization’s Address/P.O. Box Number:*
Street Address Address Line 2 City State ZIP Code
Organization's Email

If available
Organization Website
REQUIRED– DELEGATE/ALTERNATE DELEGATE TO THE LWF CONVENTION
Each affiliate must list the names and contact information of its designated Delegate and Alternate Delegate to the Louisiana Wildlife Federation’s Annual Convention to be held annually in August. The sole purpose of the Delegate is to cast an affiliate’s final vote on resolutions at the General Assembly of the Annual Convention. The Alternate Delegate assumes this responsibility should the Delegate not be able to attend.
Delegate Name:*
Alt. Delegate Name:
Delegate Mailing Address*
Street Address Address Line 2 City State ZIP Code
Alt. Delegate Mailing Address
Street Address Address Line 2 City State ZIP Code
Delegate Phone (Home)
Alt. Delegate Phone (Home)
Delegate Phone (Mobile)
Alt. Delegate Phone (Mobile)
Delegate Email*
Alt. Delegate Email
Please complete the following contact information for your organization’s current officers on page 2 of this form or attach a comprehensive list of officers that includes the name, address, phone number(s), and email address, if available, for each officer. Also please complete the organization information on page 3 so we can update our records concerning your affiliate.
Board list or other supplemental document.
Max. file size: 512 MB.

President
Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone (Home)
Phone (Cell)
Email
V.P.
Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone (Home)
Phone (Cell)
Email
Secretary
Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone (Home)
Phone (Cell)
Email
Treasurer
Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone (Home)
Phone (Cell)
Email
Other Officer (If Applicable)
Title
Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone (Home)
Phone (Cell)
Email
Other Officer (If Applicable)
Title
Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone (Home)
Phone (Cell)
Email

How many current members do you have?*
Please provide a roster of members and their contact information, if available. This list is for our records only to verify LWF members, and will not be provided or sold to any other entity.)
What is the fiscal year of your organization?
When and where are meetings held? (e.g., 2nd Tuesday every other month, 7pm, Ruston Recreation Center)
Is your organization incorporated?*
- Yes
- No
Are you a non-profit organization recognized by the IRS under section 501(c) of the Internal Revenue Code?*
- Yes
- No
If yes, what is the specific non-profit classification of the organization, e.g. 501(c)3? 4? 7? etc.
Classification and Tax ID no.
Please list up to 3 of your top conservation/recreation issue priorities for the coming year that the LWF can be of assistance with:
OPTIONAL – AFFILIATE REPRESENTATION ON THE LWF BOARD
If they so choose, each affiliate has the option to be represented on the LWF Board of Directors by a member it so designates to serve. Refer to the “2019 Louisiana Wildlife Federation Board of Directors Agreement and Disclosure” for requirements, responsibilities and expectations of an affiliate director. Contact the LWF office at 225/344-6707 if you have questions. Directors must sign this agreement.
Affiliate Director Name
Mailing Address
Street Address Address Line 2 City State ZIP Code
Phone (Home)
Phone (Cell)
Email
Please contact the LWF office if you would like a copy of the Louisiana Wildlife Federation’s Charter & By-Laws.

Please put the LWF on your mailing list (address below) to receive any organization correspondence and newsletters. Email correspondence can be sent to lwf@lawildlifefed.org.
Completed by:*
Title*
Policy for new organizations affiliating with LWF: In the event that a new club should be affiliated within the last 3 months of the fiscal year, their dues shall cover their Federation dues for the ensuing fiscal year. A previously-affiliated organization can be considered new if it has not been an affiliate member in previous 2 years.

76901

Affiliate Application