Orange Pride Membership Registration
Name:
Address:
Town/City:
State:
 ZIP:
Phone:
E-Mail:
What is the best way and time to contact you?
Optional Information
Adults:
Children:
Pets:
Birthdays: (Month and Day) (This is optional and will be used in
the preparation of our monthly group birthday events)
Interests (check as many as you choose)
Social
Business
Political
Educational
Events
Membership
Other (Specify)
Please add me to your list of LGBT owned/operated/friendly businesses
Business Name:
Address:
City:
 State:
ZIP:
Phone:
Website:
Single ($20/year)
 Family ($25/year)
Type of Membership Desired:
Once your application and payment are received we will send you a Membership Card which entitles
you to discounts on Orange Pride events.  In addition, we are working on an Orange Pride discount
card with local merchants/businesses.  While Orange Pride is starting up, the membership fees are
going toward our legal fees so that we can incorporate and become a non-profit organization.
If you wish to join Orange Pride but cannot make the full fee payment right away, please contact us to
arrange a payment plan.

Please make checks payable to Orange Pride.
Please bring your membership fee to the next Membership Meeting or mail it to:
Orange Pride, 581 Mountain Road, Port Jervis, NY 12771.

We do not yet accept credit cards but we plan to do so in the near future.
 
 
 
 
 
 
 
 
Is this a Gift Membership?
 Yes
 No
Student ($10/year)
 Senior ($10/year)
If you wish to join Orange Pride but cannot make the full fee payment right away, please contact us to
arrange a payment plan or check box below.
We now accept credit cards.  Please check here if you wish to pay by credit card:
You will be contacted by phone to arrange a secure payment.  
Please check here if you wish to arrange a payment plan:
Please let us know if you have
additional information or
comments: