Pride of the Greater Lehigh Valley Membership Form


Pride of the Greater Lehigh Valley Membership Registration *indicates required field, though all information is important.
Level of Membership (check one)
$15 Individual General Membership
$25 Domestic Partner Membership
$50 Business Membership (non-profit)
$100 Business Membership (for-profit)

Name: *
Complete Partner's name only if submitting a Domestic Partner Membership
Partner's Name:
Address: *
City: *		State:*	Zip:*
Phone: *
E-mail: *

Check those that apply.
I am interested in becoming a Pride volunteer.
You may list my name in the Pride newsletter.

Check one:*
I'd rather receive Pride communications/newsletters via email.
I'd rather receive Pride communications/newsletters via USPS.

	By clicking the "SUBMIT" button below you will leave http://ww.prideglv.org and enter the Paypal site to make a secure payment with a credit card or existing Paypal account.