Parents, Families and Friends of Lesbians and Gays

The following form will allow you to become a member of, or make a donation to, the PFLAG DC chapter. Please fill out the form and submit it.

Your membership will become effective when you submit your membership fee online or we receive your check by mail at the following address:

Metro DC PFLAG | 1111 14th St. NW Suite 350 | Washington, DC 20005

Note: If you do not wish to submit this form via internet, then please complete the form, print it out, and mail it to the above address.

An asterisk indicates a field that you are required to complete. You will receive further information from PFLAG once you have submitted your information. (Remember, our membership is confidential.)

Name*

Address*

City*

State*

Home Phone*

Zip Code*

Fax Number

Work Number

Email

Member:

Student/Special Circumstances ($20) Individual ($35) Household ($45)
Patron ($55) Sponsor ($100) Benefactor ($250) Flag Waver ($500)
Life ($1000)

Names of those who give $100 or more will be published in our annual report OK do not publish

Active members will automatically become members of the National PFLAG organization, and will be sent the following types of mailings from the National PFLAG office. Please mark the items you DO NOT want to receive.

The quarterly National PFLAGPOLE
National fund-raising solicitations

Donor: $

Donation in memory of/tribute to (name of deceased/honoree):

Please check the box if you DO NOT want to receive the PFLAG DC Chapter newsletter.