<p> Lupus Foundatio of Virginia Inc. P.O. Box 25418 Richmond, VA 23260-5418 Membership Application </p><p>Membership’s dues come directly to LUPUS FOUNDATION OF VIRGINIA, INC. One automatically becomes a member of the chapter nearest him/ her. (Mr. / Mrs. / Miss) First ______MI_____Last______Address______City______State______Zip Code______Phone#______(H) ______(W) ______(C)______E-Mail______(New Member____Renewal) Please check whether single or family, plus other types Type’s __Single ($10) __Supporting ($25) __Patron ($100) Membership __Family ($15) __Sponsor ($50) __ Courtesy (Free) Lifetime ($500) ___Corporate (1,000) ___Honorary Send membership dues online via PayPal or by check to the address listed above. MAKE CHECKS PAYABLE TO: LUPUS FOUNDATION OF VIRGINIA, INC.</p><p>Do you have lupus? __Yes __ No Sex: ____Female ____Male Race, for research purposes: ______Caucasian, Black, Asian, Hispanic, American Indian, Other</p><p>I WOULD LIKE TO VOLUNTEER TO HELP WITH THE FOLLOWING: Membership____ Public Relations____ Patient Education____ Fund Development ___ Special Projects____ Finance____ Support Groups____ General Office Work____</p><p>How did you learn about our organization? Physician____ Friend____ Family Member____ Patient Information Line____Office Line____ Newspaper____ Website____ Organization Newsletter____ Phone Book____ Other____ Please explain______If you would like more information, please specify topic(s). </p><p>DONATION AND MEMORIALS ARE TAX DEDUCTABLE TO THE FULL EXTENT ALLOWED BY THE LAW! OPTIONAL DONATION AMOUNT______WE WELCOME YOU TO OUR ORANIZATION!</p><p>WE ARE PLEASED THAT YOU HAVE DECIDED TO JOIN OUR ORGANIZATION OR CONTINUE YOUR MEMBERSHIP WITH US. THERE IS POWER IN NUMBERS! BY WORKING TOGETHER WE CAN ACCOMPLISH MANY OBJECTIVES FOR THE GOOD OF ALL WHO ARE AFFECTED BY LUPUS, DIRECTLY OR INDIRECTLY! </p>