PFLAG  Membership Form
Thank you for considering becoming a member of PFLAG [NAME]! Your membership dues help us to accomplish our advocacy and outreach goals. As a member, you are eligible to vote in board meetings if you want to make an even greater impact on our efforts to support your LGBTQIA+ loved ones and neighbors.

Every day, PFLAG [NAME] offers support, advocacy, and hope to members of the LGBTQ+ community, their families, friends, and all allies. Our work is possible because of you. The generous contributions of our members and donors support our website and our tabling/outreach/advocacy efforts. We are an all-volunteer organization, so every penny of your donation is vital and goes directly to our work.  

Membership Information and participation in chapter activities is kept confidential

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Name (Chosen; First & Last) *
Pronouns *
Name (Legal; First & Last) *
Email Address *
Mailing Address *
Phone Number *
Which membership level are you interested in?  *
Do you have additional members in your household?  *
Family Member Name and Pronouns
Family Member Name and Pronouns
Family Member Name and Pronouns
Family Member Name and Pronouns
Family Member Name and Pronouns
If you have additional family members to add please reflect remaining Names and Pronouns here, separated by line.
Do you identify as (please check all that apply)
Which of the following best describes you?
Clear selection
Age
Are you interested in volunteering with PFLAG XXX
Clear selection
Are you interested in learning more about open board positions within the chapter? 
Clear selection
Submit
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