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LA Phi Beta Lambda

3820 J. Bennett Johnston Avenue Lake Charles, LA 70615 Phone: (337) 491-2608 Fax: (377) 491-2135

Application for State Office

Name & school: Address: City/st/zip: Phone: Curriculum: Birthday: School eMail: Month Pager/cell: Estimated Graduation: (semester year) Day

(Signed)

(Date)

Please write the office you are interested in with a paragraph stating your qualifications. Turn in this form with a resume and letter of recommendation.

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