Arlington Gay and Lesbian Alliance

The Commonwealth of Virginia's Oldest Continuously Operating Nonpartisan LGBT Organization

AGLA Membership Form

Fill out this form and click Submit. The following window gives instructions on completing your membership based on whether you pay by check or online credit card.

AGLA is a 501(c)(3) non-profit organization. Your dues, as well as other contributions, are tax deductible in accordance with applicable IRS regulations. ©1997-2010 AGLA. All Rights Reserved. E-mail: info@agla.org.

Type of Membership:
Member Name:		Gender:
Partner Name:		Gender:
Any children? (Please include names and birth dates.)
Payment Method:	Check Online Credit Card
Contact Name (for Business or Organization):
Address:
City:
State:
ZIP Code:
Home Phone:
Work Phone:
1st E-mail Address (required for PayPal):		Subscribe to our e-mail list? Yes
2nd E-mail Address:		Subscribe to our e-mail list? Yes
I am interested in volunteering to help in the following areas:
Community Service:	Yes No
Political Awareness:	Yes No
Social Activities:	Yes No
Safe Schools Projects:	Yes No
Comments: