LRFA

Latvian Relief Fund of America


LRFA is a professionally managed, non-profit, mutual assistance organization, designed to provide our members with affordable health care plans and financial assistance in emergencies. We support other Latvian-American organizations and education in the U.S. and abroad.
Membership Benefit Plans About Us Forms Contact Us
Information Request Form
New Membership
Renewal Membership
Change of Address
Benefit Plan Enrollment
Travel Plan Enrollment
Benefit Claims
Make a Payment

New LRFA Membership Application

You may download the Adobe Acrobat enrollment form to print/mail or enroll online below.
To use the downloadable form, you will need to have the Adobe Reader installed. If you do not have it, you can download it for free from  Adobe.

Enroll Online

Please select your Membership Type and provide the information below: ( Red indicates a required field)

Annual Membership Fees are $30 per person ($15 for children under 18).
Lifetime Membership cost is $500 per person.
In addition, a one-time registration fee of $20 applies for ALL new applicants.
Your membership is for the current calendar year and is renewable annually, unless you are a Lifetime Member.
Select one:

 



First Name
Last Name
Middle Initial
Date & Place of Birth
Billing Address
Address (line 2)
City
State/Province
Zip/Postal Code
Country
Telephone
E-Mail Address
Occupation
Children under 18 (name and date of birth)
Family members who are LRFA members
(name and membership number):
I prefer to receive information in:
Latvian
English

Your Total Membership fees: $

(Optional) I would like to receive information about:
Medicare Supplemental Plan
Prescription Drug Plan
Health Supplemental Plan
Hospital Supplemental Plan
Emergency Accident & Plan For Visitors From Abroad
Travel Medical Plan
Mortuary Benefits Plan

(Optional) Questions and Comments:

Your Signature:
I wish to become a member of LRFA! The above information is true to the best of my knowledge. I support the principles and work of LRFA.

© 2017 LRFA   -   P.O. Box 8857, Elkins Park, PA 19027-0857   -   info @ lrfa.org

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