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Send form with your check to P.O Box listed below) The information you fill in on this form will be kept securely on a computer that is not connected to the internet. |
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mailing lists and all information we receive is held in strict confidence.
Full Name: _________________________________________________ Address & Apartment: ________________________________________ City: _______________________________ State: ________________ Zip Code: _____________________ Phone (daytime): ________________________________ Phone (evening): ________________________________ Fax: ___________________________________________ E-Mail: _________________________________________ Company Name, etc.: _______________________________________
I wish to support the Coalition's efforts on behalf
of the community. I wish
My contribution is: ( ) $1,000.00 ( ) $500.00 ( ) $250.00 ( ) $200.00 ( ) $100.00 ( ) $75.00 ( ) $50.00 ( ) $25.00 ( ) other Annual Dues $25.00 ( ) Renew Year 2005 Dues ( ) Pre-pay 2006 Dues ( ) ( ) I can help with publicity. ( ) I can distribute newsletters, important flyers, etc., in my building. I need ( ). ( ) I can attend meetings, hearings etc. ( ) I can help with: __________ . Are you affiliated with any groups that you think
we should know about?
Please make Check or Money Order payable to CALW,
Inc. |
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