Membership

Application for Membership

If you are interested in becoming a member of the Coalition, please fill in the form below.

First Name

Your first name

Group Memberships (Current and Past):

Street Address

City/Town

Country

How long at Current Address

Contact Info

Age group

Skills

Last Name

Your Surname

If "Other Interest", Please indicate

Areas of Interest

How did you hear about Freedom Coalition SLU?

Name of References

Why do you want to be a member of Freedom Coalition SLU?

I agree to support the objectives of the Coalition. I agree to pay $10.00 Registration fee and a Coalition support pledge of $5.00 per month. Donations are welcomed

I agree to abide by the Code of Conduct and to adhere to the Rules of the Freedom Coalition SLU

Method of Payment

Date of Payment

Amount Paid