Register - LOAF

First Name*

Last Name*

City*

State*

Zipcode*

Partner First Name

Partner Last Name

I wish to receive LOAF’s monthly eNewsletter and email reminders*
- Yes
- No
Please check what information may be published in LOAF’s eNewsletter*
- Name
- Photo - including event photos
- Birthday
- Do not publish any of my information
Name of a LOAF member who already knows you
I may at some time be interested in volunteering with LOAF in the following ways (training is provided):
- Welcoming new members at events
- Sending out birthday cards
- Care Team Calls
- Sharing ideas for events
- Researching grants
- Applying for grants
- Assisting with TheaterLOAFers
- Assisting with ActiveLOAFers
- Assisting with weekday Lunch Bunch
- Uploading Photos to the website
- Assisting with the eNewsletter
- Other administrative tasks
Scholarship
- I am requesting a scholarship
Scholarship information is kept confidential
I am requesting a scholarship for the following reason(s):

Members Directory
Would you like to be displayed on our private members directory? (optional and you can change your answer later)
- Yes include me in the Members Directory
- No don't include me in the Members Directory
Below, choose what information you would like included in the members only directory. (If you ever want to update this information, remember the directory section and account section are separate).
Your preferred contact email
Bio for my Membership Profile
Preferred Address
Preferred Contact Phone number Required phone number format: (###) ###-####
Date of Birth
Enter your partner's name as you'd like it to appear in the Members Directory

Account Credentials
Your email is also your username that you can use to login. Please note you can only login after your application is approved.
E-mail*
Password* Please make sure to choose a strong password! Minimum length of 8 characters.
Repeat Password*
Honeypot

Members Directory