Annual Membership Dues

( ) $250 Business Membership

( ) $150 Rainbow Pioneer

( ) $30 Individual

( ) $50 Household*

( ) $10 Student

Name: _______________________________________________________________________

* Please include the names of all household members

Address______________________________________________________________________

City:______________________________________________ State:______ Zip:___________

Email: _______________________________________________________________________

I would like to volunteer, please call me:

Day: ( )___________ Evening: ( )_____________ Other: ( )_____________

Prefer To Be Contacted Via Email :____________________________________________

Committees:

Events: __ Grants & Fundraising: Outreach: _ Newsletter: ___

Communications/Mailing: _ Other: ___