ANNUAL MEMBERSHIP FORM

Friend of PFLAG Cape Girardeau:

Thank you for becoming a member of our thriving chapter! PFLAG is an organization working to create a caring,
just, and affirming world for LGBTQ+ people. We support families, educate allies, and advocate for equality
through our network of supporters, members, and chapters across the country.

Your donation enables our chapter to fund scholarships for local graduating seniors, purchase educational materials,
and support LGBTQ+ events.

To contact Pflag, please leave a message at 573-542-0496 and we will get back to you. To stay connected, please
follow us on Facebook: https://www.facebook.com/pflagcape and watch your email for future announcements and
volunteer opportunities.
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PFLAG CAPE GIRARDEAU MEMBERSHIP/RENEWAL

DATE: ____________________
NAME(S):_____________________________________________________________________________________
ADDRESS: ____________________________________________________________________________________
CITY: ______________________________________________ STATE: _________________ ZIP: ______________
HOME: (______) _________________ PHONE (______) _________________ CELL: (______________)
EMAIL ADDRESS(ES): __________________________________________________________________________
SUGGESTED DONATION LEVELS
_______ Individual $25.00 _______ PFLAG Ally $60.00
_______ Household $40.00 _______ PFLAG Advocate $120.00
_______ Other $_______ _______ Over-the-Rainbow $240.00+

PLEASE ENTER CHECK# HERE: ___________

I am enclosing an additional tax-deductible contribution of: $_____________.

Turn in this form at a PFLAG meeting, email an electronic copy to pflagcape@gmail.com, or

mail check to:

Pflag Cape Girardeau
c/o First Midwest Bank
1820 N. Kingshighway
Cape Girardeau, MO 63701

Contribute by PayPal at
Pflag Cape Girardeau