MEMBERSHIP FORM CFI-DC 621 Pennsylvania Avenue Washington, DC 20003 ---------------------------------------- Yes! I want to be a Friend of the Center for Inquiry DC. CHOOSE A MEMBERSHIP CATEGORY: [ ] Individual Member at $60 per year [ ] Family Membership at $80 per year [ ] Contributing Member at $125 per year [ ] Supporter at $250 per year [ ] Patron at $500 per year [ ] Benefactor at $1,000 per year ---------------------------------------- Name: [____________________] Address: [____________________] City: [____________________] State: [____________________] Zip: [____________________] Phone: [____________________] Email: [____________________] ---------------------------------------- Charge my: [ ] MasterCard, [ ] Visa Account #: [______________________________] Expiration: [______________________________] Signature: [______________________________] - OR - [ ] Check or Money Order enclosed Make checks payable to Center for Inquiry DC and mail to: CFI-DC 621 Pennsylvania Avenue Washington, DC 20003 You can also become a member by calling (202) 546-2331 Membership Forms can be faxed to (202) 546-2334 ---------------------------------------- Contact Elizabeth Daerr for further information at (202) 546-2331 Web Site: http://www.cfidc.org E-mail: info@cfidc.org