Preview mode
Published
Copy responder link
Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
PFLAG Cambridge Membership Registration
Please join PFLAG Cambridge as an official chapter member! Annual membership (beginning in October of every calendar year) is $40 per household. Please read this form carefully (especially the dues part!)
* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone number
*
Your answer
Address
*
Your answer
City, State, Zip
*
Your answer
Pay Annual Membership Fee by PayPal
*
You may pay by PayPal or by Check/Cash (see below). With PayPal, PFLAG Cambridge will be charged a fee - please consider helping with this expense. We are a small and low-budget organization!
Pay Annual Fee with PayPal - $40
PayPal Processing Fee (optional) - $2
Will Pay by Check or Cash at Meeting or by Mail (see below)
Donation of additional $5
Donation of additional $10
Donation of additional $20
Donation of additional $50
Donation of additional $100
Required
Payment Options without PayPal
*
Please make checks payable to "PFLAG Cambridge"
Pay by Cash or Check at PFLAG Cambridge meetings (3rd Tuesday of month at Beloved Therapy)
Pay by Check by mail (to: Beloved Therapy, 414 W Main St; Cambridge, WI 53523)
Will pay with PayPal (see above)
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report