Form

New Membership Form

Please fill it out to type in text of those blank boxes.
Please, After you done fill up & Print it this form, to do yourself to printing it then along with your check (NO CASH) to mailing this address:


WISCRAD
Milw. LGBT Community Center
Attn: Treasurer – Membership

1110 N. Market St.

 Milwaukee, WI 53202


Thank you

First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
VP (Video phone):
Payment $20 / one year: $
Donation is appreciate: $

Email:
Comments:

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