Application Form


  • Complete the online application form below.
  • Drop by and complete an application form on the spot.
  • Request a membership package to be mailed to you via phone or email.


Inquiries


Contact: Linda Johnson, Membership Director
Telephone: (502) 852-6996
Fax: (502) 852-0163
Email: linda.johnson@louisville.edu

Applicant's Personal Details

Spouse's Personal Details
Title:
Title:
First Name:
First Name:
Last Name:
Last Name:
Social Security #:
Gender:
Gender:
Birthday:
Birthday:
Age Group:
Age Group:
Contact Information - Home
Address 1:
Address 2:
City:
State:
ZIP:
Home Phone:
Cell Phone:
Home E-mail:
Contact Information - Business
Employer:
Profession:
Business Address Line 1:
Business Address Line 2:
City:
State:
ZIP:
Business Phone:
Business E-Mail:
Application Type
Member Category:
Regular Member Type:
Referred by:
Spouse Card:
An additional membership card can be provided for your spouse for a $5 fee.
Billing
Initiation fee will be paid by:
Monthly dues will be paid by:
I understand that there is a 1.5% finance charge per month on any unpaid balance.Cancellation of membership must be submitted in writing to the membership director along with any balance due.

Please allow five days for processing.