The New York Association for Gender Rights Advocacy
Membership Application Form

This information is kept confidential. Members will receive our newsletter and ongoing announcements via e-mail regarding NYAGRA's activities.  You do not have to reside in the state of New York to join NYAGRA.

INSTRUCTIONS:

For Internet: Complete the blanks on the form, then click submit, once you get to our confirmation page -- your application has been received. From there to pay your dues, click on the "Click'n'Pledge" link. There you will be able to pay your dues by credit card.

For post-mail: 1. fill in blanks, 2. print form, 3. include check or money order,
4. Mail to: NYAGRA, 24 W. 25th St, 9th floor, New York, NY 10010

contact name
membership card name
telephone
street address
City, State, Zip
email address
gender identity (opt)			sexual orientation (opt)
age (opt)			ethnicity / race (opt)
check box if all contact from NYAGRA should be discreet
membership options (please check one):
	$20 basic annual membership
	$10 annual membership (students, senior citizens, limited income)
	I want to be a NYAGRA member but need a fee waiver
	I want to make an additional tax-deductible contribution of			$
payment method: (please check one):
	I will pay my membership dues via the Click'n'Pledge gateway
	I will print this form	and mail it to NYAGRA with a check or money order.
CIVIL NAME:			Today's Date: