Langston Wildfire Relief Sign up Application

Langston Bar Association – Wild Fire Relief Gift Card Donation

The Langston Bar Association is donating a $100 gift card to support current members who have experienced the complete loss of their primary residence due to fire.

Eligibility Criteria

Must be a current 2025 dues paid member of the Langston Bar Association as of September 15, 2025.
Only one gift card per residence/household.
The home must have been completely destroyed resulting in a complete structure of the home being lost to fire that requires a full rebuild.
The home must have been the member's primary residence.
Partial damage (e.g., smoke or water damage) does not qualify.
Deadline to Apply: November 3, 2025.

Applications must be submitted by November 3, 2025.
Gift cards will be mailed directly to the address provided.

Note: Funds are limited and gift cards will be distributed on a first-come, first-served basis.

Full Name*

First NameLast Name

E-mail*

example@example.com

Phone Number*

Format: (000) 000-0000.

Address of destroyed property*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YesNo

Mailing address for delivery of the gift card*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please verify that you are human*