Membership Form for PFLAG Danville-San Ramon Valley

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We are a 501(c)(3) organization that depends on your membership and donations to support our services. 100% of membership fees and donations are tax deductible. Please note that $15 of every chapter membership goes towards membership in PFLAG national.

Is this a: *

New Paid Membership

Renewal Paid Membership

Name (First and Last) *

Email *

Address (Street, City, State and Zip Code) *

Phone number *

I would like to receive emails from PFLAG National: *

Yes

Please select which membership you would like: *

Student ($15)

Individual ($25)

Household ($40)

Benefactor ($50)

Sustainer ($100) -- any donation at $100 or more will be recognized in our newsletter, which we will first check with the donor

Other:

Required

Please write your primary membership name (The first person listed will be the primary member, but you may list a couple such as Alex and Morgan Brown): *

Please add any other household members as part of your membership (Household, Benefactor or Sustainer level):

To pay your membership online, you may send payment via PayPal to srvpflag@gmail.com. So that we may confirm your payment, please list the name associated with your PayPal account if you are paying via PayPal:

Please note you may prefer to mail a check to PFLAG Danville-San Ramon Valley Chapter, P.O. Box 40, San Ramon CA 94583. If you would like us to send a payment reminder, please mark below:

Please send me a reminder to mail my check

I do not need a payment reminder

Other:

Clear selection

THANK YOU for your support of PFLAG Danville-San Ramon Valley!

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