Membership Application Form

/Membership Application Form
Membership Application Form 2018-05-29T14:41:36+00:00

To become a member of the Life Raft Group, fill out the membership application below.
All information is confidential.

Information provided will be kept strictly confidential and is for the internal use of the Life Raft Group only. We are committed to protecting the privacy of our members. Any data or information that we share in any way is always cleansed of any identifying information in order to protect confidentiality.

If you fax the form, make sure that your contact information (phone or email) is on the first page you send. Occasionally people send failed faxes with no way to contact them.

Next Steps:

If you are already an LRG Member
Update Your Medical History

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