KYSAFF Membership Form

Yes! I want to become a member of the Kentucky Self-Advocates
For Freedom!

Please complete this application and mail it with payment to:

Kentucky Self-Advocates For Freedom, Inc.
PO Box 23555
Lexington, KY 40523-3555 USA

Name:
Address:
City:
State:
Zip Code:
Phone:
Email:

What type of membership would you like?

 

Individual with a disability - Annual Dues $20

Family member/support person - Annual Dues $25

Other Individual Membership - Annual Dues $40

Organization - Annual Dues $100

Chapter Membership - Annual Dues  Group information form        



Thank you for your application!