Pacific Northwest Chapter

Join LFA

Join LFA to learn more about lupus and bring additional resources and attention to the fight against lupus.

Join LFA - Pacific Northwest Chapter

Please fill this Membership application and mail with your payments to the chapter office.  

Your membership starts the day we receive your membership fee in the office.

Date of application or renewal:
Contribution: $
In memory of:
In honor of:
First/Middle/Last:
Payment Amount:
(check only) 		$  
Address:
City: State: Zip:
Home Phone:
Work Phone:

Please make the checks payable to:
Lupus Foundation of America
Pacific Northwest Chapter

800 5th Avenue, Suite 4100

Seattle, WA 98104

Email:
I am a lupus patient: Female Male
I am a relative of a lupus patient: Relationship:
Membership: New Renewal
Address Change:
Individual ($20.00/Year):
Family ($30.00/Year):
Professional ($30.00/Year):
Courtesy ($0.00/Year):
I would like my name included in the newsletter:
I would like to remain anonymous:
Please delete my name from mailing list:
Yes! I'm interested in helping With:
Health Fairs Phoning
Mailing Lupus Walk
Newsletter Office Help
Publicity Outreach
Fundraising Board of Directors
Other
 

Lupus Foundation of America, Pacific Northwest Chapter is a tax-exempt charitable organization under IRS Code (501)-(c)-(3). Your Payment receipts are sent in the mail.