LFDA Membership Interest Form

Please fill out the following information to submit a request for LFDA membership review.

**NOTE: Annual dues are $150 for Allied Members or $150 per year per registered Embalmer and/or Funeral Director submitrted to the Louisiana State Board of Embalmers and Funeral Directors in the previous year.

If you are a Funeral Home that is not currently a member of LFDA, please submit information here and a LFDA staff person will contact you regarding your membership dues. q
Questions? Please contact the LFDA office at (225) 376-2193 or info@lfdaweb.org.

* Required Information

Member Type:

Membership Cost:	Number of Employed Embalmers/Funeral Directors
First Name:*
Last Name:*
Organization:
Title:
Street Address:*
Street Address (cont):
City:*
State/Province:*
OR Other:
Zip/Postal Code:*
Country:
Primary Email:*
Secondary Email:
Do you agree to receive e-mail correspondence from the association and its members?:*	Yes No
Do you agree to receive pertinent information related to issues covered by the association from interested third party entities?:*	Yes No
Phone:
Username:*
Password:*	Minimum of Six Characters
Confirm Password:*