Membership Application
Your membership dollars support PFLAG being a presence in the community for everyone that comes next. Whether it be future parents, LGBTQ+ people and families who need support, or other organizations that will benefit from PFLAG’s presence and education.
Full Name
*
First Name
Last Name
Phone Number
*
E-mail
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Names of Additional Household Members (if applicable)
Membership Options
prev
next
( X )
Individual Membership
This membership covers one adult individual.
$
20.00
Household Membership
This membership tier covers all members of your household, including children.
$
35.00
Extra Donation
This is not mandatory, but PFLAG Midland-Odessa uses donations to fund its programming and events.
$
5.00
$5
$20
$50
$100
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: