Membership Application Form

Membership Application

To apply for membership please complete all questions.
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State

Zip Code
E-mail
Home Number

Area Code Phone Number
Individual Level of Membership

Student (HS/College) - $10 Friend - $25 Family - $50 Partner - $125 Supporter - $200 Donation only
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: