Yes, I wish to join PFLAG

Please complete this form, print it, and mail to

PFLAG
Box 3741
Winchester, VA 22604

*$25 individual       $35 couple
(Please make check payable to PFLAG of Winchester/Lower Shenandoah Valley).
*Includes $15 dues to national PFLAG for each voting member.
Additional donation for local chapter:

Name:
Address:
City, State and Zip:
Phone:
E-mail:

Newsletter preference: (note: "yahoogroup" email newsletter and non-specific return address for surface mail is used to maintain anonymity. If you wish, you can join the yahoogroup and elect to not receive any emails, controlling access to the information by signing onto the group via the Internet to read any announcements.)
Mail:      Email:     None:


THANK YOU!

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