Membership Information and Application

      Membership are valid for 1 calendar year
MEMBERSHIP WILL: MEMBER BENEFITS:
   Help give a 'voice' to youth who might 
     otherwise be lost to suicide.
   Be a 1 year term.
   Help us work toward removing the stigma 
     associated with suicide by bringing this topic out 
     in the open where efforts undertaken to halt the 
     progress of this epidemic.		     By becoming a member of Yellow Ribbon
      Suicide Prevention Program® you not only make
       a financial contribution to our organization, you 
      show that you are making a commitment to 
      suicide prevention. You lead by example in 
     demonstrating your belief that “It’s OK to Ask 4 
      Help!”®. 
    New Memberships receive: 100 Lifeline Cards, 
      Lapel Pin, 15% Discount on Yellow Ribbon 
      merchandise and events
    Receiving notice of events, national updates, and 
      program developments via the YRI_listserve
 
Supporting Membership Operational Membership
[ ] Student / Senior Citizen $15 (Include name of school below)  [ ] Youth Colub $50
[ ] Individual $25   [ ] Program Site (Single) $150
 [ ] Family $50  [ ] Program Site (Multi) $$250
[ ] Organization $100 (not an operating program site) [ ] Chapter $150
[ ] Patron $250+ and above [ ] Chapter ((501 c3 status) $500
   

   

  
.        
Applicant / Renewal Information
Name:_____________________________________ Title: _____________________________________
Name of School:_____________________________ Organization Name: __________________________
Address:_____________________________________________________________________________
City:______________________________________ State:__________   Zip:____________
Phone:____________________________________ E-mail:____________________________________
Website:___________________________________ Birth date (Senior/student): ____________________
    Optional questions:
    1. Are you a suicide survivor?  ___ Y   ___ N   Who did you lose? _________________________________
       Their relationship to you _______________________  Their date of birth ______________  Anniversary date: _______
    2. Would you like to be included in the Yellow Ribbon Network listerve?  ___Y    ___N
Payment Method:
___ Check  ___ Visa    ___ Master Card   ___American Express   ___ Discover
Card Number: ________________________ Expiration Date:_______________________
Signature for card:_________________________________________________________

I agree to abide by the Basic Principles, Policies and Mission of LFLI/YRISPP and to remain a member in good standing during the length of my membership.

Application Signature:  ____________________________________________________

Mail to:  Yellow Ribbon International, P.O. Box 644, Westminster, CO 80030-0644
Please allow three weeks for your membership confirmation.
Attach this membership application to the order form if you are ordering other items.

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© 1995- 2005 Yellow Ribbon Suicide Prevention Program®  ~  Light for Life Foundation International
MAIL: PO Box 644, Westminster, CO 80036-0644  ~~ SITE: Orchard Court School, Adams County SD 50
 303.429.3530    Fax 303.426.4496    www.yellowribbon.org    Email: ask4help@yellowribbon.org