Get Involved: Membership Form

Please complete the following online membership form. Upon submission, you will be provided a link to pay the $45 membership fee via a credit card donation through Network for Good. Or you may print a registration form (PDF) to mail with your check to a chapter address below.


Your information is held in the strictest confidence!      *required fields

Chapter Membership (Please choose a chapter*)
South Bay Chapter (based in San Jose; serving Mexico and southern California); mail application and dues to LMV, PO Box 445, Los Gatos, CA 95031-0445.
Gold Country Chapter (based in Auburn; serving Mexico and southern California); mail application and dues to LMV, PO Box 6467, Auburn, CA 95604.
High Sierra Chapter (based in Truckee and Reno; serving Mexico and southern California); mail application and dues to LMV, PO Box 8234, Truckee, CA 96162.
Central America Chapter (for Central America trips, regardless of your US location); mail application and dues to LMV, 755 E William St, San Jose, CA 95112.

Membership Information
*First Name:
*Last Name:
*Date of Birth:
 (mm/dd/yyyy)
*Address 1:
Address 2:
*City:
*State:
 *Zip:
Phone (Home):
 (xxx-xxx-xxxx)
Phone (Work)
 (xxx-xxx-xxxx)
Phone (Cell)
 (xxx-xxx-xxxx)
*Email:

Healthcare Professionals
Medical  Dental  Optometry  Chiropractic  Other
Certification/Specialty

Volunteer Pilots
Note: To become an LMV pilot-in-command you must have at least 500 hours and meet certain other requirements. Please refer here for more information.
Pilot Ratings:   Hours-To-Date:

General Volunteers
How would you like to help us?
(Examples: Use my professional skills, serve on committees, assist health care teams, etc.)

Spanish Language Proficiency (All Volunteers)
Proficiency level: None  Conversational  Fluent
Interpreters: Healthcare vocabulary/other related proficiencies?

Additional Information
How would you like to receive your monthly LMV newsletter? email  regular mail
Hobbies, special interests and skills:
How did you hear about us?
Comments: