This is how we will refer to you
**Payment not required, pending board approval
It's a formality!
Your legal name
Your legal name
You'll be directed to another site for payment processing after submitting this form
If applicable
Oregon
Optional - though we'd love to know when to celebrate your special day!
Please note: emails sent to you will refer to your chosen name
Optional- though is necessary if you prefer calls or text messages regarding updates or critical info
Essential that we don't out you
Select only one please
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