SAGE: Advocacy & Services for LGBT Elders
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What Do SAGENet Affiliates Do?
Letter of Interest

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Interested in becoming a SAGE affiliate? Please use this form to submit a Letter of Interest. Learn more about SAGE and LGBT aging online at and
First Name* Middle Initial
Last Name*
Email* Phone*
Mailing Address (1st line) Mailing Address (2nd line)
City State Zip Code
If you are part of an organization, please provide the following information:
Organization Name
If you are part of a community-based effort, what is the working name of your group?
Please note, potential affiliates are not allowed to use the SAGE name until you are officially an affiliate.
Instead, we suggest that you create a temporary name to describe your group. However, you are welcome to
share with your community that you are working towards becoming a SAGE affiliate.
Please tell us why you would like to join SAGENet.

*Required field
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