EMERGENCY CAMPAIGN AGAINST VOUCHERS
MEMBERSHIP FORM

If you would like to join the Emergency Campaign Against Vouchers, please print out this form and fill out the form below completely. Please fax the form to (212) 486-5673 or send it to Emergency Campaign Against Vouchers, c/o American Jewish Committee,165 East 56th Street, New York, NY 10022. If including a contribution, please make the check out to Emergency Campaign against Vouchers.

PLEASE TYPE OR PRINT CLEARLY
Name __________________________________ TITLE ________________
Organizational Affiliation __________________________________    
Day Phone __________________________________ Fax Number ________________
Street Address __________________________________    
City & State __________________________________ Zip Code ________________
e-mail __________________________________    

Please indicate below whether you are interested in becoming an organizational or individual member.
Organizational Membership
No political party may be listed as a member. All organizations (including churches/synagogues) that are members of Emergency Campaign against Vouchers must: 1) Agree to have their organization’s name listed publicly as a member and 2) Make a one-time contribution (of anywhere from $5 to $250) through an organizational check, if the organization has not already done so. If your organization has not made a previous contribution, please enclose a check with this mailing (organizational checks only).

[ ] Please list my organization as a member. This is the way I would like my organization listed (please print or type clearly): ____________________________

Individual Membership
All individual members of the Emergency Campaign against Vouchers must agree to have their name listed publicly. Only individuals who are elected officials and/or members of the clergy will be provided with additional identification when their names are listed. For purposes of uniformity, we would prefer not to uses such prefixes as "Mr.," "Mrs.," "Miss," "Ms.," or "Dr.," but we will honor professional degrees if listed after your name and, if it is very important to you, any prefix that you designate below. If a couple wants to be listed, please provide us with first names and understand that individuals will be listed alphabetically by last name. No contribution is necessary to become an individual member, but we must have your mailing address (not just e-mail).

[ ] Please list me as an individual member. This is the way I would like my name listed (please print or type clearly): ____________________________

This form should be sent to the Emergency Campaign against Vouchers,c/o American Jewish Committee,165 East 56th Street, New York, NY 10022 or fax it to (212) 486-5673. If including a contribution, please make the check out to Emergency Campaign against Vouchers.