Membership Application
Interested in just learning more about membership? Click the Contact tab, then Contact Us and select "Memberships" on the contact form. Interested in joining? Please enter your contact information and any other fields you wish to share. If you have any questions regarding the application please contact the office at 607)319-0162. Thank you and welcome to the LLH Community!
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First Name
Last Name
E-mail
Phone
Cell phone (if different)
Date of birth
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Marital status; please choose
Gender
Sexual Orientation
Ethnicity
Address (ex. 830 Hanshaw Rd., Ithaca NY 14850)
Are you interested in an individual or household membership?
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Do you want to start with a free 3 month trial membership?
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I approve my address and contact information being shared in the "Members Directory" only viewable to other members.
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Do you have any mobility issues or special needs? If so, please describe. 
What are your hobbies or interests?
How did you find out about us?
What interests you about becoming a member?
I would like to learn more about scholarship opportunities
I would like to learn more about volunteer opportunities
Additional comments (optional)
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