Membership Application Form

Address

E-mail
Home Number

- Area Code Phone Number
Individual Level of Membership

Student Membership - $5 Single Membership - $20 Family Membership- $35 Donor Membership - $100
Enter the message as it's shown *
Submit form and mail check,
payable to FTLSP:
FTLSP, PO Box 493, Taylorsville, KY 40071
Should be Empty: