You are so important in this struggle! we, the members and leaders of Families for Lead Freedom Now!, welcome your interest and will get in touch as soon as we can.

please print and fill out the application.

Please mail it to:

Families for Lead Freedom Now!
c/o Legal Services of Central New York
221 South Warren St. #300
Syracuse, NY 13202

Thank YOU!


Membership Application: Families for Lead Freedom Now!

Printed First Name & Middle Initial

 

________________________________________________­­­­_________________

Printed Last Name

 

_________________________________________________________________

 

Today’s date: ____/____/______Phone: ______________________________

 

Email: __________________________________________________________

 

Address, zip: _________________________________________________________________

 

Signature: ______________________________________________________

 

Best way to Contact me: □ Call  □ Text  □ Email  □ Knock

Directly Affected Family: ___  Affected Community Member:___­­__

Registered to vote? □ Yes      □ No     Supporter:____