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\viewkind4\uc1\pard\qc\b\f0\fs22 PFLAG Central Dakota\par
Membership Form\b0\par
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\pard\sl-215\slmult0 Would you like to become a member of PFLAG Central Dakota?\par
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\ul \ulnone $5.00 per household (Local dues)\par
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\ul \ulnone $15.00 per household\tab\par
($10.00 for membership in\par
National PFLAG)\par
($5:00 for membership in \par
\pard\fi-720\li720\sl-215\slmult0\tx720 \tab Central Dakota PFLAG)\par
\pard\sl-215\slmult0 (Tax Deductible)\par
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\ul \ulnone $30.00 contributing membership\par
\tab\par
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Yes, I would like to become a PFLAG member at the level indicated above.\par
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No, I cannot become a member at this time, but I have enclosed a contribution of\par
\ul \ulnone $10\ul \ulnone $20\ul \ulnone $50\ul \ulnone $100___$Other\par
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\ul \ulnone I would like to be put on your mailing & email list.\par
\ul \ulnone For confidentiality purposes, please do not send any mail to my address.\par
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Date:\ul \ulnone Phone:\ul \ulnone\par
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Name(s)\ul \ulnone\par
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Address:\ul \ulnone\par
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\ul \ulnone\par
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email \ul \ulnone\par
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For more information, call 701/223-7773\par
Mail to \par
PFLAG\par
P.O. Box 2491\par
Bismarck, ND 58502-2491\par
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