MEMBERSHIP/RENEWAL FORM        MEMBERSHIP/RENEWAL FORM

Please print and complete this form and send it with your check or money order to: PFLAG/Lansing Area P.O. Box 35 Okemos MI  48805

Special Contributing Member $100.00

Individual $20.00

Contributing Member 50.00

Newsletter Only $10.00

Family or Household $30.00

Other Donation $____.

Name:

Telephone (optional):

Address:

City, State, Zip:

Please make checks payable to PFLAG/Lansing Are

PLEASE NOTE: PFLAG/Lansing Area is a tax-exempt, non-profit organization under IRS code 501(c)3, group exemption #3366.  Be sure to consult your tax expert to see if any of your dues may be tax-deductible.

Membership in PFLAG/Lansing Area allows you to have:

Membership in YOUR local chapter. Allows you to help fund the cost of YOUR bi-monthly newsletter. Membership in PFLAG/National Allows you to receiver the PFLAGPole - the National Newsletter. Allows you to help make a difference.