Membership Application
Preferred Name ___________________________________ Legal Name _______ _____________________________________
Address __________________________________________________________________ Apt ______________________________
City ___________________________________________ State __________________ Zip ______________________________
Date of Birth: __________________ _______ _____________
Month Day Yr (Optional)
Phone Number _________________________________________________________
Email Address ________________________________________________________________
Significant Other's Email ____________________________________________________________ (optional)
I prefer not to receive any mail from Crossroads. _______ I prefer not to receive any email from Crossroads. _______
Membership dues are $25.00 maximum per calendar year expiring on March 31st. New members joining after April 1st will be prorated $2.50 per month. After January 1st, the $25.00 would include the next year. Make checks payable to: Crossroads, c/o Membership Secretary. Monthly Gathering fee for members is $5.00.
Your spouse or significant other is encouraged to join as an associate and attend meetings. Associate yearly dues are $5.00 with full voting rights. The Gathering fee for an Associate is $2.00.
Significant Other’s name ______________________________________________ Date of Birth: ___________ _______ ______
Month Day Yr (Optional)
Upon receipt of application and payment, your membership card will be mailed to the mailing address above, or issued to you at the next gathering you attend. Please let us know the best way to get it to you.
Please notify Crossroads of address changes. If your membership has expired, please provide us with your previous mailing address and membership number to assist in locating your file.
By signing my name (legal or preferred), I certify that the named applicant:
- is interested in transgender activities from a personal or scientific viewpoint,
- will not release personal information about another member or attendee without prior consent, and
- that the applicant is at least 18 years of age.
For those that do not wish to reveal their legal name, the application may be signed with an alias or initials to indicate the Code of Ethics and Confidentiality is understood. Crossroads promotes friendships, education, and the understanding of gender issues and is not for the purpose of sexual encounters.
Each member will abide by the Constitution and By-Laws established by this Non-Profit Incorporated club, in the State of Michigan, as a social club governed by its Board of Directors.
Signature _________________________________________ Date __________________
For Official Use Only
Membership Type: Full____ Associate ____
New ___ Renewal ____
Membership Number __________________
Address __________________________________________________________________ Apt ______________________________
City ___________________________________________ State __________________ Zip ______________________________
Date of Birth: __________________ _______ _____________
Month Day Yr (Optional)
Phone Number _________________________________________________________
Email Address ________________________________________________________________
Significant Other's Email ____________________________________________________________ (optional)
I prefer not to receive any mail from Crossroads. _______ I prefer not to receive any email from Crossroads. _______
Membership dues are $25.00 maximum per calendar year expiring on March 31st. New members joining after April 1st will be prorated $2.50 per month. After January 1st, the $25.00 would include the next year. Make checks payable to: Crossroads, c/o Membership Secretary. Monthly Gathering fee for members is $5.00.
Your spouse or significant other is encouraged to join as an associate and attend meetings. Associate yearly dues are $5.00 with full voting rights. The Gathering fee for an Associate is $2.00.
Significant Other’s name ______________________________________________ Date of Birth: ___________ _______ ______
Month Day Yr (Optional)
Upon receipt of application and payment, your membership card will be mailed to the mailing address above, or issued to you at the next gathering you attend. Please let us know the best way to get it to you.
Please notify Crossroads of address changes. If your membership has expired, please provide us with your previous mailing address and membership number to assist in locating your file.
By signing my name (legal or preferred), I certify that the named applicant:
- is interested in transgender activities from a personal or scientific viewpoint,
- will not release personal information about another member or attendee without prior consent, and
- that the applicant is at least 18 years of age.
For those that do not wish to reveal their legal name, the application may be signed with an alias or initials to indicate the Code of Ethics and Confidentiality is understood. Crossroads promotes friendships, education, and the understanding of gender issues and is not for the purpose of sexual encounters.
Each member will abide by the Constitution and By-Laws established by this Non-Profit Incorporated club, in the State of Michigan, as a social club governed by its Board of Directors.
Signature _________________________________________ Date __________________
For Official Use Only
Membership Type: Full____ Associate ____
New ___ Renewal ____
Membership Number __________________
Click the icon below to download a PDF file of the 2011 Application Form.
Download; complete; deliver with payment (mail or return at meeting)
Download; complete; deliver with payment (mail or return at meeting)
| |||
