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NOW MEMBERSHIP APPLICATION
To join the local chapter of NOW (South Palm Beach County Chapter),
send us the following information:
(Please print this out, fill in the blanks, and mail it in.)
First Name: _________________ Last Name: ______________________________
Address: ___________________________________________________________
City: ____________________________________ State: ____ Zip: ________
Home phone: ______________________ Other phones: ___________________
E-Mail Address: _____________________________________________________
If you are a snowbird, you might want to give us your summer address
and/or whether you want our newsletter to follow you out of state.
Regular dues: $35
Reduced dues: $20 - $34
Amount enclosed: $____________
Please make all checks payable to SPBC NOW -
P.O. Box 880213 * Boca Raton, FL 33488-0213
Check areas of interest:
__ Reproductive Rights __ Civil/Human Rights __ Programs
__ Health Care __ Women's Center __ Outreach
__ Violence __ Membership __ Education
__ Economics __ Newsletter __ Older Women's Rights
__ Child Care __ Fundraising __ Women and Prison
__ Other (specify)
__________________________________________________________________
If you do not have the time to be active, it is still important for you
to join and be counted among those women, and men, who support our goals!
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Chapter Number FL0540
To be completed by Chapter Treasurer only:
Total National Dues Accompanying this form: ___________
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