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MEMBERSHIP APPLICATION
Membership is open to persons 16 years or older.

SELECT MEMBERSHIP STATUS*
New Member
Renewal
SELECT MEMBERSHIP TYPE*
Individual
Family (same residence; two persons)
Student

Name:*

First


Last
Address:*

Street Address


Address Line 2

City

State
ZIP
Email Address:*

Enter Email


Confirm Email
Phone Number:

Primary Phone *


Secondary Phone

I AM INTERESTED IN THE FOLLOWING AREAS:
Criminal Justice
Education
Environment
Healthcare
Membership
Voter Services
Women's Issues
Other
Please describe 'Other'
Payment Method*
PayPal/Credit Card
Check
Payment Amount*
Individual membership
($60/year)
One $60 payment
Two $30 installments
($30 now; $30 in 6 mos.)
       
If you select "PayPal" you will be taken to PayPal to pay with either your PayPal account or your credit card
If you select "Check", your information will be submitted and an email will be sent to you with instructions for sending your check. Your membership will not be active until your check is received.