Lesbian and Gay Democratic Club of Queens
Membership
MEMBERSHIP FORM - Print this form. Then complete and it and mail it in!
Today's Date _______________________________________________________
Name _____________________________________________________________
Address___________________________________________________________
___________________________________________________________________
___________________________________________________________________
Telephone __________________________________________________________
Email ______________________________________________________________
New Member or Renew? _____________________________________________
Level of Membership: General $15 Sustaining $25 Supporting $50 Lifetime $125 ____________________________________________________________________
Today's Date _______________________________________________________
Name _____________________________________________________________
Address___________________________________________________________
___________________________________________________________________
___________________________________________________________________
Telephone __________________________________________________________
Email ______________________________________________________________
New Member or Renew? _____________________________________________
Level of Membership: General $15 Sustaining $25 Supporting $50 Lifetime $125 ____________________________________________________________________
Please make your check payable to LGDCQ.
Mail the completed form with your check to:
LGDCQ, Post Office Box 857, Jackson Heights, New York 11372
Please note that all memberships are for the calendar year. Membership checks received after November 1 apply to the following calendar year.
Mail the completed form with your check to:
LGDCQ, Post Office Box 857, Jackson Heights, New York 11372
Please note that all memberships are for the calendar year. Membership checks received after November 1 apply to the following calendar year.
