Perceptions

STEP 1: Complete the form below to provide your membership information to Perceptions.
The fields marked in red are required.

Select membership type:

Select how you prefer to receive our newsletter:
Snail Mail E-Mail

Check here if you'd like a Personalized Name Tag:
(First names listed below will be used)

Title (Mr, Ms, Dr, etc)	First Name	Last Name	Email Address		Phone	Date of Birth mm/dd/yy / /	Gender	Sexuality
Title (Mr, etc)	First Name	Last Name	Email Address		Phone	Date of Birth / /	Gender	Sexuality
Title (Mr, etc)	First Name	Last Name	Email Address		Phone	Date of Birth / /	Gender	Sexuality
Title (Mr, etc)	First Name	Last Name	Email Address		Phone	Date of Birth / /	Gender	Sexuality
Street Address			Apt		Perceptions occasionally sends informational mailings. Check here if you do NOT want any mail sent to your home:
City		State	Zip -	+4	Home Phone

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 address and personal information will always be kept confidential. Perceptions will never share or sell your information. Italicized demographic information is requested so that we can better serve you.