Contact Information
Name required:

email required:

Address:

City, State, Zip:

Home Phone:

Work Phone:

Preferences
Dues shown are annual.
Lifetime starts at $250 per person.
FOL Dues Amount ($15 per person):

NPCA Dues Amount ($35 per person):

Extra Contribution Amount:

Designation for Extra Contribution:

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Information for the FOL Membership Directory
What years where you in Lesotho:

District and Village:

Work done in Lesotho:

Current Occupation:

Family members:


Comments:

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