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Contact Information |
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Email Us
3024
Willow Pass Rd., Ste. 200
Concord,
CA, 94519
Phone:
925.692.0090
Fax:
925.692.0091 |
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Membership/Donor Interest Form
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Name |
____________________________________ |
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Address |
____________________________________ |
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City |
____________________________________ |
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State |
____________________________________ |
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ZIP Code |
____________________________________ |
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Home Phone |
____________________________________ |
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Work Phone |
____________________________________ |
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E-Mail |
____________________________________ |
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Date |
____________________________________ |
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I would like to become a Member.
___ $25 Regular
___ $20 Senior (>55)
___ $20 Youth (<21)
___ $40 Family/Partner
___ $50-$149 Friend
___ $150-$249 Supporter
___ $250-$449 Champion
___ $500-$999 Board Partner
___ $1,000 (or more) Benefactor
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___ I would like to be on the Mailing list.
___ I would like to be a Volunteer.
___ Please be discreet when calling.
___ Please send mail in a
plain envelope.
___ My employer can match my contribution.
Note: to pay by credit card, please call the Center. |
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Demographic Information
(confidential, for statistical use only):
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Date of Birth:
_______
Years with RCC ________
Sexual Orientation:
___ Gay
___ Lesbian
___ Bi
___ Questioning
___ Heterosexual
Gender:
___ M
___ F
___ TG
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Ethnicity:
___ African-American
___ Asian/PI
___ Caucasian
___ Hispanic
___ Native American
___ Other
Household Income (Optional)
___ < $25,000
___ $25,000 - 40,000
___ $40,000 - 75,000
___ $75,000 - 100,000
___ > $100,000
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If you just want to receive email updates,
send an email with your
name, phone number, address, and
.
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For
online membership form,
click here.
Membership Includes:
---> Email updates on special events at the Center and around the
Bay Area
We look forward to seeing you at
Contra Costa County's
only LGBTQ community center!
Instructions: Please print either
pdf (35 Kbs) or
Word (25 Kbs),
fill out form and mail it to:
Rainbow Community Center
3024 Willow Pass Rd., Ste 200
Concord CA 94519
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