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Louisiana Domestic Violence Hotline:
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MembershipLCADV Membership Application
LCADV
Name: ____________________________ Organization: ______________________ Address:__________________________ City, State, Zip: ____________________ Telephone: ________________________ Fax No.:___________________________ E-Mail: ____________________________ Type of Membership:__________________ Active Individual Membership is open to formerly battered women. Supportive Individual and Supportive Family Membership is open to individuals or families interested in supporting the work of the Louisiana Coalition Against Domestic Violence. Supportive Corporations/Organization Membership is open to businesses and non-profit organizations that are interested in supporting the work of the Louisiana Coalition Against Domestic Violence. Active Organizational Membership is open to organization that are private, non-profit, community based programs that provide direct services to battered victims and their children. To be eligible for Active Organizational Membership the organization must also act in accordance with and adopt both the philosophy and the principles of unity of the Louisiana Coalition Against Domestic Violence. For information regarding Active Organizational Membership or for an application, please contact the LCADV office at: 225-752-1296. Dues: Active Individual $5.00* Supportive Individual $15.00 Supportive Family $25.00 Supportive Corporation $150.00 Supportive Non-Profit Organization $50.00 Or if you would like to make a tax-deductible donation to further the work of the Louisiana Coalition Against Domestic Violence just enter the amount you would like to donate below. A note of thanks will be sent to the address above as a record for your income taxes. Donation $ Thank you for your generous support. Please print this completed page and mail it along with your membership dues or donation to the address above.
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