Indy PFLAG
Membership Application and Renewal Form

It is your membership donation that allows us to spread helpful information to more than 200 people, schools and agencies each month through our newsletter and our outreach and advocacy efforts. Your membership helps us provide resources so that we can continue to support new families. Your donation is powerful. You can print this form and send it with your check to the address at the bottom.

NAME:    _______________________________________________________

ADDRESS:   _____________________________________________________

CITY:    __________________________________STATE: ___  ZIP: _________

TELEPHONE:  _____________________________________________________

E-MAIL:   ________________________________________________________

NEW MEMBERSHIP: __________   RENEWAL: ___________


Please check the type of membership desired and attach dues:

___ INDIVIDUAL . . . . . . . . . . . . . .$35.00 

___ FAMILY . . . . . . . . . . . . . . . .$45.00
 
___ SUPPORTING. . . . . . . . . . . . . . .$75.00 

___ OVER THE RAINBOW. . . . . . . . .  . .$100.00 or more

NOTE: Dues include membership in both local & National PFLAG and are tax deductible.


Make membership checks payable to Indianapolis PFLAG and mail to: 

                           Membership

                           Indianapolis PFLAG

                           P. O. Box 441633

                           Indianapolis, IN 46244-1633