Complete this form to register as a Friend with Perceptions.   (Red fields required.)

Title (Mr, Ms)

First Name

Last Name

Street Address

Apt #

City

State

Zip        -

(+4 ext)

Home Phone

Cell Phone

Work Phone

Email Address

Gay Lesbian Bisexual Transgender Straight

Select any categories you would be interested in volunteering:

Admin Support (stuff envelopes, post flyers, validate contacts, etc)
Charitable Work (participate in Day of Caring, Adopt-A-Highway, etc.)
Event Support (help with Valentine's Dance, Pride parade, Holiday Party, etc.)
Monthly Meeting Support (provide refreshments, help set-up/take-down)
Represent Perceptions (be a greeter, staff a booth, ride on our Pride float, etc.)
Speakers Bureau (educate the community by telling your personal story)

Other:



Privacy Statement. We value your privacy. Your name, address, and other personal
information will always be kept confidential. Perceptions will never share or sell your information.