Please Print this Membership Application

DEMOCRATS FOR NEW POLITICS
2010 Membership Application

 

Name………………………………………………………………………………………. Address……………………………………………………………………………………. City…………………………………....………………….... Zip………………………….

E-Mail address ………………………….

Would you like to receive your monthly newsletter via E-Mail      __Yes     __ No

Telephone………………………….

Individual membership is $15.00 ........

Family membership (up to two members) is $ 25.00 …..

Senior Citizens (Over 65 Years Young) is $10 ……

Please make check payable to:

DEMOCRATS FOR NEW POLITICS
P.O. BOX 610216
Bayside, N Y 11361

(Additional contributions are graciously accepted)

Dues may be mailed or brought to our Membership Meeting