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ADA Membership/Donation
Form
Become an ADA member by printing this page and mailing it to:
Southern California Americans for Democratic Action
8124
W. Third Street, Ste.102
Los Angeles, CA 90048-4328
I'M PROUD TO BE A LIBERAL!
I WANT TO JOIN/REJOIN ADA.
Enclosed are my annual
membership dues
(Includes membership in ADA & the Southern California Chapter.)
I'm
not able to join / rejoin ADA now. Enclosed is my donation of $_______ to
support your programs.
Because of our political
activities, contributions to SCADA and ADA are not
tax deductible.
Please print
information clearly
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Name as
it appears on credit card
_______________________________________________
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Day
telephone:______________________
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Address_________________________________________
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Evening
telephone:_______________________
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City____________________________________________
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Zip
Code:____________________
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E-mail__________________________________________
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Fax:_____________________________
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(Indicate
form of payment by checking box) Credit
Card:
___Visa
___Master Card
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Card
No.____________________________________ Expiration date______________________
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Check
– [Make checks payable to SCADA] Cash
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