PRINT THIS FORM

YES! I want to join/renew with NWPC-AN.

Enclosed is my check for annual membership dues, which entitles me to full voting membership and receipt of national, state and local newsletters.

[ ] $70 Regular Membership
[ ] $ _________ Sliding Scale ($20 minimum)
[ ] $90 Supporter
[ ] $125 Sponsor

Please make checks payable to NWPC-AN

Please mail to:

Patricia Dilks
NWPC-AN Treasurer
97 Selkirk Street
Oakland, CA 94619

I want to help NWPC achieve its goals. Enclosed is an additional contribution of $ _________________________

Name: _______________________________________

Address: _____________________________________

_____________________________________________

Phone: _______________________________________

Email: _______________________________________

PRINT THIS FORM