Membership Url Your preferred name * This is how we will refer to you Membership type * New Renewal Scholarship ** **Payment not required, pending board approval Application date * It's a formality! First name * Your legal name Last name * Your legal name Payment option * $40.00 - Annual dues, for EMAILED versions of our monthly newsletter $50.00 - Annual dues, for MAILED HARDCOPIES of our monthly newsletter You'll be directed to another site for payment processing after submitting this form Address * City * Apt. # If applicable State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Oregon Zip code * Birth date Optional - though we'd love to know when to celebrate your special day! Email address Please note: emails sent to you will refer to your chosen name Phone Optional- though is necessary if you prefer calls or text messages regarding updates or critical info Who do we ask for? * Essential that we don't out you Preferred contact method * Call Text Email Postal mail Select only one please Consent * I agree that all info is true and accurate I agree that the information provided is for myself alone. I also understand that this application is incomplete without payment. Made to our fiscal sponsor PrideNW (for NWGA membership) through a third party service - GiveLively.org