Make Checks Payable to PFLAG Detroit

Membership Application
(please print)

Name _____________________________________________________________
Address ___________________________________________________________
City __________________________ State _______ Zip Code _______________
Email _____________________________________________________________

󠇆 Put me on PENS (PFLAG Electronic Notification System)

Telephone numbers: Home __________________ Cell ___________________

󠇆 New 󠇆 Renewal 󠇆 Change of Address

󠇆 Contact me for Volunteer Opportunities via: ___ Email ___ Mail ___ Phone
󠇆 Send $15.00 from this donation and my personal information to register me with PFLAG
National.

󠇆 DO NOT send my personal information to PFLAG National.

Dear PFLAG Detroit,

Please accept my tax-deductible donation to help support your work in “Keeping Families
Together”.
$35.00 Individual

Sincerely Yours, $45.00 Household

$55.00 Supporting
________________________________
$105.00 Contributing

$1000.00 Lifetime
Mail to: PFLAG Detroit
PO Box 1169
Royal Oak, MI 48068-1169 Donation of Support