The first name you'd like us to refer to you by.
The last name you'd like us to refer to you by.
If you don't have any, enter N/A.
For care packages and other goodies. It's OK to use a friend's address or a PO box if you don't have a permanent address.

LASC New Member Application

Fill out this form to apply for membership in the Los Angeles Spoonie Collective. Membership includes participation in our collective care web, so we’ll be asking you some questions about your capacities and needs. If you need assistance filling out the form, please email us at [email protected] or contact us on Instagram or Facebook

We look forward to being in community with you!

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