LAVA Membership Intake Form

MM slash DD slash YYYY
Your name
Address
Are you the primary contact for your organization?
Additional contact information
Address
Can your logo be used on communications and marketing materials?

Accepted file types: jpg, png, Max. file size: 50 MB.

Membership Levels and Benefits

Please select the level of membership you would like to apply for. Note that membership is a one-year membership renewable annually.
Membership levels
Any donation above the base membership level. This field is required for donor level.

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