Joining and donating are different acts. In order to protect your privacy, we ask that you formally join The Coalition if you want to receive our newsletter and other information. Thank you.

You may print out this page and mail or fax it to:
UCC Coalition for LGBT Concerns
2592 West 14th Street
Cleveland, OH 44113
800-653-0799
216.861.0782 fax
office@uccCoalition.org

Or, you can copy and paste the items below and send the information in an email to office@uccCoalition.org or print it out, fill it in and fax it to 216.861.0782.

Name(s)
Address
City/State/Zip
Home Phone
Cell Phone
Work Phone
Fax
Email Address
Church name (if applicable)
UCC Conference

Are you willing to receive occasional emails at this email address from The Coalition about items of interest to The Coalition membership? ___ Yes ___ No

Do you want WAVES, The Coalition newsletter, made available to you electronically rather than sent by post? ___ Yes ___ No

Sign up for The Coalition electronic newsletter, Ripples, via the button in the left column labeled, Subscribe Now!.

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Yes! I pledge my support to The Coalition.

Checks may be made payable to "The Coalition" or you may contribute via credit card. You may also donate online or via other means. Please see the donation page for more information. Please also feel free to include The Coalition in your estate planning.

___$50 Donor
___$100 Supporter
___$15/mo or $180 Friend
___$25/mo or $300 300 Club
___$35/mo or $420 Sustainer
___$500 to $1,499 Benefactor
___$1,500 & up Angel
___$ ________ other gift

Please indicate:

• ____ This is an annual gift.
• I/We will pay this amount ___monthly ___quarterly ___semi-annually
• _____ I will submit the authorization form for The Coalition to deduct this amount from my checking account.

Credit Card information:

Name on card
Account Number
Expiration Date
Zip Code

___ I will contribute time and talent. See below. Please contact me.

___ I would like to be registered as a member.

___ Yes, you may list me in print as a member.

___ Yes, you may list me in print as a contributor.

___ Please keep my membership confidential.

___ Please keep my contribution confidential.

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Volunteer Opportunities

Here is a PDF for you to fill in and send to The Coalition office. Lots of opportunities await you!

The UCC Coalition
2592 West 14th Street
Cleveland, OH 44113
800.653.0799 tel
216.861.0779 tel
216.861.0782 fax
email: office@UccCoalition.org

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