HGLP Membership Form

PRINTABLE MEMBERSHIP FORM
HOUSTON GAY & LESBIAN PARENTS     [Return to HGLP Home]
(YOUR HGLP DUES ARE TAX DEDUCTIBLE)

Items marked with an asterisk (*) are demographic information and for statistical purposes only.

PARENTS:
First Name
Last Name
B-Day (mm/dd)
Work/Cell #
E-Mail
* Orientation (G/L/B/T)
     
                              
     
                              
 

FAMILY:

Address/Street

City

State

Zip

Home Phone #

Single/Couple

     
                              


CHILDREN:
First Name
B-Day (mm/dd/yy)
Age
* Origin (adoption, AI, foster, het rel., related, surrogacy, wananbe)
     
                  
     
                  
     
                  
     
                  
     
                  
     
                  

SPECIAL DATES:
Date:
Years:
Comments: (anniversary, adoption, joint conservatorship, etc)
                 
                 

          PAYMENT:                                                       PARTICIPATION:
Item:
Amount:
Explanation:
Check if you would like to be considered
when we get a request for:
Dues
      
$35 or what you can afford
Phone Interviews c
Donation
      
Would you like to make a
tax deductable contribution?

Radio Interviews c

TV Interviews c

TOTAL
      

Please make Check payable to
HGLP and return to:
HGLP Inc
2476 Bolsover St #815

Houston, TX  77005-2546

Photographs c

Videotapes c
Panel Discussions c
Surveys c
 

Mailing Address: _______________________________________________________________________________________________
Do you consent for event pictures of your family to be included in the newsletter? (First name only)     c  Yes          c  No
Do you consent for event pictures of your family to be posted on the HGLP website? (No names)          c  Yes          c  No