We hope you would consider supporting our work. CCEJ offers you two options for donating.
The first option is by making an online donation using a credit card or PayPal account.
To choice this option, click
the button below.
Your second option for donating is to print out the form below and mail it in with your check or money order.
NAME:
_______________________________ (H) PHONE: __________________
(W) PHONE:_______________
TITLE
& ORGANIZATION (if any):
____________________________________________________________________
ADDRESS: ____________________________ CITY, STATE,
ZIP:__________________________________________
FAX:
________________________________
E-MAIL:__________________________________________________
(check
one)
___
Individual Membership ($15.00)
___
Organizational Membership ($60.00)
___
Green Membership ($35.00)
__
Gold Membership ($60.00)
For members and donors giving $50 or more:
___ Platinum Membership
($110.00)
Would you be interested in a free CCEJ T-shirt? YES___ NO____
___
Lifetime Membership ($510.00)
If yes, please indicate shirt size:
___
Other Membership S___ M___ L____
XL___ XXL___
___
Donation ____________
___ I’m
interested in volunteering for CCEJ
PLEASE MAKE CHECKS PAYABLE TO:
CT
Coalition for Environmental Justice
10 Jefferson St, Ste. C1
Hartford, CT 06106