MEMBERSHIP APPLICATION
Thanks to all who have paid to become members of P-FLAG Columbus. Renewal is due 12
months from the date of your first payment. Check your mailing label for date. Local
newsletters will be mailed in a plain envelope.
PARENTS, FAMILIES & FRIENDS OF LESBIANS AND GAYS, COLUMBUS CHAPTER
[ ] New
[ ] Renewal
[ ] Change of Address
[ ] Please contact for Volunteer Opportunities
[ ] $ 15 Newsletter subscription Only (Not a membership)
[ ] $ 25 Bronze Membership
[ ] $ 35 Silver Membership
[ ] $ 75 Gold Membership
[ ] $100 Platinum Membership
[ ] ________ Donation
I do [ ] do not [ ] give my permission for my name to be sent to PFLAG National in order to
receive National membership benefits (such as the national quarterly publication PFLAGPole

MAKE CHECK PAYABLE TO:
P-FLAG COLUMBUS
P.O. BOX 340101
COLUMBUS OH 43234

DATE__________________________________________
NAME__________________________________________
ADDRESS_______________________________________
CITY___________________________________________
STATE___________ ZIPCODE_____________________
TELEPHONE____________________________________
YOUR DONATION IS TAX DEDUCTABLE
(FED ID #32-01211619) Our Chapter's financial statements are available upon request.
Members of Parents FLAG Columbus receive this newsletter monthly. Views expressed are
those of the authors and do not necessarily reflect the opinions of Parents FLAG Columbus or
Parents FLAG National. To contribute or assist in the creation of this newsletter, contact the
editors through our P.O. Box 340101.