Membership Information

Below is the form that we use to sign up new members. We hope to have this available to submit online in the near future.
For now, you will need to fill it out and send it to the address at the bottom. Please note the privacy statement. Thank you!

GreenBeLT Pride Membership Form

Privacy Statement: Unless you specifically indicate on this form that it is okay for us to include your information on a published list, or provide your membership and contact information to non-profit LGBT groups (only if directed by the action of our Board of Directors), we will not do so. We ask for the following information so that we may contact you concerning our organization. In addition, as we are a city-recognized group, aggregated information about our membership may be provided to the City of Greenbelt if requested.

*= required information

*First Name:
*Last Name:
Partner’s Name:
*Address:
*City:
*State:
*Zip Code:
Home Phone:
Cell Phone:
Fax:
Email:
Work Organization Name:
Title:
Work or Daytime Phone:
Birthday (mm/dd/yy):
Membership Donation($):
Additional Comments/Information:

____ By placing an 'X' here, I am granting permission for my membership and contact information to be published as part of a membership directory and shared with other LGBT non-profit groups as directed by Board action only.

Signature: __________________________
Date: __________________________

Membership is encouraged at every financial level and any amount above the minimum $10.00 is tax deductible. Send this form and your check payable to:

Greenbelt Pride
GreenBeLT Pride PO Box 122 Greenbelt, MD 20768-122