Membership Aplication

Applying as: Applying as: Individual Group/Organization Young Adult (under 21)

Name - Individual or Group/Organization

Facebook

Instagram

Twitter/X

Email Address

Address

Brief Biography of individual

Brief Description or Summary of Group/Organization

Website

Contact Name 1

Contact 1 Phone

Contact 1 Email

Contact Name 2

Contact 2 Phone

Contact 2 Email

Contact Name 3

Contact 3 Phone

Contact 3 Email

Membership Directory Info - Please select all items you would like to appear in the Online Members Directory Membership Directory Info - Please select all items you would like to appear in the Online Members Directory Group/Individual Name Bio/Group Summary Website Address Group Contact Name Social Media Handles Email Group Contact Email Group/Organization Logo (email logos to logo@livinghope1.org) Phone Group Contact Phone

I have reviewed the Membership Agreement (attached) and agree to all terms and conditions listed therein, including the Code of Conduct, and understand failure to adhere to the terms and conditions could lead to termination of membership.

Signature of Parent/Guardian of a minor (under 18):

Date