New Clothes Derby

Request for Membership Information

Thank you for your interest in becoming an Assistance League member.

Please fill out the form below. Your information will be forwarded to your local chapter’s director of membership, who will contact you with the proper application requirements. All your personal information will be treated as confidential.

Leave this field empty
How did you find out about Assistance League? (Check all that apply.)
Please provide your contact information: (Required fields are listed in red with an asterisk.)
Please select the chapter you are interested in joining.
Chapter names are grouped by state.