PACT Atlanta

PACT Membership Application

(page 1 of 4)

To join PACT Atlanta or renew your membership, complete the application below.

Name

Postal address

City

State

Zipcode

Home phone number

Cell phone number

Email address

Birthdate

Parter Information

(page 2 of 4)

Please skip this section if you do not have a partner.

Partner's Name

Partner's cell phone number

Partner's birth date

Name Listing Preference

(page 3 of 4)

In future BWMT-Atlanta publications, please indicate how you would like to have your name listed.

Name listing preference Complete name (first and last name) First name and first initial of last name

Areas of Interest

(page 4 of 4)

Please indicate your area of interest or expertise.

Web design

Activities / Social committee

Fundraising

Grant writing

Pride committee

Hosting a potluck

Please indicate how you would like to assist the chapter

Please type the letters below to prove you are human

Thank you for your submission! Someone from PACT Atlanta will then contact you shortly.

Membership for the year is $20 for a member, $30 for a couple. Please mail payment to: PACT Atlanta, PO Box 14858, Atlanta GA 30324 or give to a Steering Committee member at any event. Our membership year runs from July 1 to June 30.

PACT Atlanta does not distribute its mailing list to anyone outside its membership, but cannot guarantee that the mailing list will not find its way into the hands of commercial businesses that will use it for commercial purposes. PACT Atlanta works diligently to maintain and respect the confidentiality of its members and its mailing list, but at the same time can assume no responsibility for its use outside of the organization.

PACT Membership Application

Parter Information

Name Listing Preference

Areas of Interest

Activities

Member Resources

Fun Stuff

Local Weather

Content on this page requires a newer version of Adobe Flash Player.

Contact Us

About Us