2026 LCRA Membership Renewal Application | Louisiana Cancer Registrars Association

Name

First Last

Job Title

Credentials (Ex.: CTR, RHIA, RHIT, etc.)

Address

Street Address Address Line 2 City Zip

Phone

Name of Facility/Institution

Business Address

Street Address City State ZIP Code

Business Telephone:

Business Fax:

Email (one email address only)

Please check where you would like to receive information from LCRA:

Education or Other information you would like to include:

Please check if you are interested in serving on a committee:

LCRA News: One benefit of membership is the “LCRA Newsbreak” which is provided by email and posted on the LCRA website at www.lcra-usa.org.

New Member Applying For (please check)

Former Member in Good Standing Hereby Applying For (please check)

Years of experience in registry:

APPLICANT SIGNATURE:

Date