Individual Application

If you would like to become a member of L.S.F.A. and receive the benefits that come with membership, fill out the form below.

This form will create a printable application that you can then mail in along with your dues.

Please fill out all appropriate fields

Your Department must be a member to qualify for Individual Membership - If your department is not yet a member of LSFA they can sign up now using our online form - Click here

Application Type:

ACTIVE FIRE FIGHTER $6.00
Title:
First Name: (no initials or nicknames)
Middle Initial: .
Last Name:
Department/Orginization:
Social Security #:  XXX-XX-XXXX
Date of Birth: // MM/DD/YY
Work Status:
Other: Explain