MEMBERSHIP FORM

MEMBERSHIP FORM

Your information is NEVER shared. Your home address is only used to verify your state legislators and to assign you to the correct regional group. By becoming a member, you are agreeing to receive periodic emails from us. We only send emails to keep you informed of important updates, and you can unsubscribe at any time. This is a way for us to be able to keep in touch with you, which is becoming more and more important as censorship is getting worse. THANK YOU for joining this movement to protect our human rights and health freedom!
Name*

First NameLast Name
Facebook Profile Name (if different)*
Instagram Profile Name*
Email*
example@example.com
Cell Phone Number*

Area CodePhone Number
Address (only for verifying state legislators & regional group, we will NOT mail you anything)*

Street Address

Street Address Line 2

CityState

Zip Code
Parish*
If you need to find your STATE legislators go HERE then come back to complete the form.
Louisiana STATE Representative (NOT Scalise, Richmond, Higgins, Johnson, Abraham or Graves)*
Louisiana STATE Senator (NOT Cassidy or Kennedy)*
Would you like to volunteer? If yes, please select all the areas you're interested in.*

Fundraising Team (we rely 100% on donations, help make it fun & effective!)Marketing Team - it can be any of the following: graphic design, creating memes/graphics for social media, writing blog posts, researching statistics or studies, etc. *If you have a specific talent/skill/interest, please specify in the Other box below.Website maintenance (SEO, updates, etc)Politics Team (polling candidates'/legislators' views, calling/emailing/writing legislators about bills, etc)Events Team (helping us with various tasks before/during an event)No, I am not interested or able to volunteer right nowOther
Are you interested in any kind of leadership role?

YesMaybeNo
IMMUNIZATION EXEMPTIONS FOR SCHOOLS & DAYCARES IN LOUISIANA

It is very important that everyone, especially our members, is aware of their right to an exemption, the requirements for submitting one, and what to do if it is denied (which is illegal but unfortunately it does happen).

The exemption law applies to ALL schools and colleges, both public AND private (including Catholic schools) as well as licensed daycare centers.

It does NOT matter whether or not the school receives funding from the government.

To submit an exemption, the parent/guardian simply turns in a written statement to the school/daycare stating that he/she is claiming an exemption to the immunization requirement (no need to explain why).

*It does NOT need to be notarized.
*It does NOT have to be from a doctor, unless you want a medical exemption, but it is not necessary since Louisiana allows personal/philosophical and religious exemptions for schools and daycares.

Some schools ask that you submit one at the beginning of each school year. Simply print the same one you used before and sign and date again.

For a more thorough explanation of Lousiana's vaccine exemption law, along with a sample exemption you can print and use, please visit
healthfreedomla.org/exemptions

If your exemption has been denied or you've been told the school/daycare doesn't accept exemptions (even though doing either is illegal), please go here and read the FAQ for exemptions for what you can do.
Please confirm you have read ALL of the above about immunization exemptions for schools and daycares in Louisiana.*

Yes, I read it.
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