Gay, Lesbian and Affirming Disciples Alliance, Inc.

Use this form to

register for the 2010 GLAD Event "It's Your Story to Tell"
become a member
renew your membership
contribute to GLAD Alliance

Once you fill out the form, click the PayPal logo below and complete your transaction with PayPal.

GLAD Event Registration (Please note that $5 has been added to cover our costs for Paypal payments.)
GLAD Event Meals and Housing (Meals are all you can eat with gluten free, lactose free and vegetarian options available.)
GLAD EVENT Scholarship Support Please consider offering scholarship support for students and low income members.	$
Early Registration Discount valid until May 15	$
Roommate/Partner If you have registed for double occupancy or for a couple room, please enter the name of your partner or roommate. If you do not have a roommate, we will assign one.

GLAD Membership Contribution

Over and Above Contribution (Supports the general mission of GLAD Alliance)
	$

Contribution to the Chuck Carpenter Leadership Development Fund (Supports participation by students, seminarians and low income persons in GLAD Alliance activities)
	$

Name	First Last
Partner's Name
Congregation
Address
Address 2
City	State Zip
Phone
E-Mail

Total	$

Press the PayPal button to complete this transaction via PayPal. Once on PayPal, be sure to indicate your "Shipping Address" so we can acknowledge your contribution.

GLAD Alliance Inc.
P.O. Box 44400
Indianapolis, IN 46244-0400

glad@gladalliance.org

Gay, Lesbian and Affirming Disciples Alliance, Inc.

Memberships and Contributions