Consider giving to our organization. It's very simple to do, just:
NAME:
_______________________________ (H) PHONE: __________________
(W) PHONE:_______________
TITLE
& ORGANIZATION (if any):
____________________________________________________________________
ADDRESS: ____________________________ CITY, STATE,
ZIP:__________________________________________
FAX:
________________________________
E-MAIL:__________________________________________________
(check
one)
___
Individual Membership ($10.00)
___
Organizational Membership ($50.00)
___
Green Membership ($25.00)
__
Gold Membership ($50.00)
For members and donors giving $50 or more:
___ Platinum Membership
($100.00)
Would you be interested in a free CCEJ T-shirt? YES___ NO____
___
Lifetime Membership ($500.00)
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
P.O.
Box 2022
Hartford, CT 06145-2022