Following the August flood, LFT is working to establish a database of impacted members. Please complete this form and return it to LFT to help us determine the extent of need and to help us allocate resources. Last Name * First Name * LFT Local Chapter Name * Original Address Temporary Address Mailing Address Work Mailing Address Job Title Work Site Name Current Home Phone Mobile Phone Work Phone Email If you have a FEMA or insurance claim, or description of loss,please send a copy to LFT. You may mail it to 9623 Brookline Avenue, Baton Rouge, LA 70809, Email it to disasterrelief@lft-aft.org, or FAX it to (225) 923-1461. Please check all that apply. My primary residence has been condemned. I have been displaced. My primary residence (which I own) has structural damage. My car is a total loss. My car has significant damage. My personal property suffered significant damage: Furniture Electonics Appliances Clothing Estimated value of personal property loss: Do you have other information that you'd like to share with LFT? I certify that the information provided in this application is correct to the best of my knowledge. Name: Date: Leave this field blank
