MEMBERSHIP APPLICATION FORM

Please fill out the form

Name:
Address:
Address Two:
City:	State: Zip:
Telephone:
E-Mail:

Yes, I would like to be a member and receive your newsletter. (Suggested yearly donation is $15.00 yearly to help with costs of postage and printing of newsletter and other FLIP related expenses but any donation is accepted.   Please do not let inability to pay stop you from joining and supporting FLIP. All donations and contributions are tax deductible and are greatly appreciated. Give what you can to help this cause.)
Here is my donation of $

send to:                         Press Here to Printable Form & Address
FLIP, Families with Loved ones In Prison
710 Flanders Avenue, Daytona Beach, FL 32114
Questions? Call: (904) 254-8453

I can't give money but I am enclosing stamps
(Amount & Address Above.)

I am interested in going to Tallahassee when needed.

I am willing to be a FLIP representative for the correctional facility where my loved one is located in order to get FLIP information to the families and loved ones there. (We need at least one person for each visiting day at every facility to inform people of FLIP and we will educate you on how to do this without breaking any facility rules.)

Please Select:

Comments or Other Volunteer Work

For More Information Contact:

Nadine Anderson, Executive Director
710 Flanders Avenue
Daytona Beach Florida 32114
Phone: 904-254-8453

or
Contact your local chapter