Minnesota NOW Membership Application

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YOUR INFORMATION:

Name ___________________________________________________________

Address _________________________________________________________

City _________________________________State ________ Zip __________

Phone - Home ________________________ Work _____________________

E-mail address:___________________________________________________

I wish to become a member of _________________________________ Chapter.*
If you know what the chapter number is, please list it here. MN __ __ __ __

*Your annual dues include membership in National NOW, Minnesota NOW, and a local chapter if you select one.

DUES:

____$35.00 Regular Annual Dues

____Limited-Income Annual Dues (Minimum required $ 15.00)

If you cannot afford the minimum requested dues, please contact Minnesota Now to ask about opportunities to earn a "Membership by Volunteering" 10 hours of service.

____I would like to add an additional contribution of $ ________ at this time.


$_________Total Amount Enclosed or Authorized To Charge (continue below)

Please mail this form with your payment to:

Minnesota NOW
550 Rice St., #102
St. Paul, MN 55103

Please make check payable to: Minnesota NOW.

OR

With my signature below I am authorizing a charge for the "TOTAL AMOUNT" indicated above: