PFLAG Queens Chapter
Parents, Families and Friends
of Lesbians and Gays

Membership Form

Dear PFLAGers,

I would like to join and help support the Queens Chapter in all the work in which it is dedicated to:
supporting our children, help educate the public to end discrimination against them and to advocate for
their rights.

Please (accept/renew) me as a member:

I want to be there to help you achieve these goals.

= = = = = = = = = = = = =  = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = =
INVOICE
Annual Membership Dues

Check Appropriate Category
/  / Family      $35.00
/  / Senior      $15.00
/  / Individual  $30.00
/  / Student     $15.00
/  / Additional contribution (Any amt. welcome)______

Name: _______________________________________________________
Address: ______________________________________________________
City:________________________ State:________ ZIP: ________________
Phone:_________________________________

(Kindly make your check payable to: P-FLAG QUEENS

Mail your check with this invoice to: P-FLAG Queens Chapter
PO Box 750212
Forest Hills, NY 11375

(Your Notes and Comments are welcome!

Last updated 7/7/2005 by LDN