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The Phoenix Chapter of Parents, Families and Friends of Lesbians And Gays (and Bisexual, Trans, and "Questioning" People).  Proudly serving the Valley of the Sun...and beyond!

 

PFLAG Phoenix Membership / Donation Form

YES, I want support PFLAG Phoenix
and held advance it's mission of support, education, and advocacy!

 

CONTACT INFORMATION:  All members and donors must complete this section.

ALL information submitted is for PFLAG Phoenix’s internal use only and will not be shared without your express permission below..
Note:  Shaded fields below are required.

Your Name:   ** Spouse/Partner:  
* Business or Organization Name:   Home Phone:  
Street 1:   Work Phone:  
Street 2:   Cell Phone:  
City:   *** Email Address:  
State:    Zip Code:    

 

                                        * Business or Organization Name:  Provide business/organization name if you will be a member through that entity.

                                      ** Spouse/Partner Name:  Provide name if they will share this membership with you -- not applicable to individual memberships.

                                    *** Email Address:  Needed in case we have any follow-up questions pertaining to your membership/donor form.  We will not
                                                                      add you to ANY email list, including our own, without your express permission below

 

Please select ALL statements below that are TRUE:

YES, you may call me (& leave voicemail) at any of the contact numbers I have provided above.

YES, you may send mail to the address I have provided above.

                OK to use "PFLAG Phoenix" envelope    Please use unlabeled ("private") envelope only

YES, you may give my personal contact information to PFLAG National for my membership with them (if applicable).

YES, you may notify PFLAG National that they may send me periodic fundraising solicitations (if applicable).

 

MEMBERSHIP:  All new & renewing members must complete this section.

 

Note:  All memberships below are annual memberships, except for Lifetime memberships.

Personal Memberships:

Special Memberships:

Individual Membership ($35)

Student/Special Circumstance Membership ($20)
        (No questions asked.  Does not include membership with PFLAG National)

Household Membership ($45)

Supporting Membership ($100)

Business Sponsorships:

Benefactor Membership ($250)

Business Bronze Sponsorship ($100)

Patron Membership ($500)

Business Silver Sponsorship ($250)

Lifetime Membership ($1,000)

Business Gold Sponsorship ($500)

 

DONATIONS:  Donors (and members who are also making a donation) must complete this section.

 

Donation Amount:

Donation in memory of: 

 

Donation in honor of: 

 

May we notify someone of your gift? 

 
  (please include recipient's name and full mailing address)

 

FORM & PAYMENT INSTRUCTIONS:

  1. To send your completed Membership / Donor Form to us electronically, simply click the "Submit Form" button below.

  2. A "Form Submission Confirmation" page will be displayed -- you will need to re-select your membership type and/or donation amount there.  Follow the instructions there to complete processing of your payment.

      

 

Your membership will become effective when we receive your Membership / Donation Form and your payment.

 

   PFLAG Phoenix is a tax-exempt, non-profit 501(c)3 organization that is not affiliated with any political or religious institution.
Your contribution is deductible for tax purposes as permitted by federal and state law.

 
Join the PFLAG Phoenix email list
Email:

 


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