Select/Print/Mail

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.)

Regular Member - $55.00

Dual Member (2 persons) - $ 80.00

Patron Member - $100.00

Limited Income Member - $ 30.00

Student Member (under 30 yrs. old) - $20.00 (includes membership in Youth for Democratic Action)

Sustaining Member at  $____     $50      $35     $25 every 3 months. (Minimum $25)

Along with my membership or instead of, I have enclosed my donation of $__________

to support local ADA programs with SoCal ADA {SCADA}.

Because of our political activities, contributions to SCADA and ADA are not tax deductible.

Please print information clearly                                 Date _____________

Name as it appears on credit card

 

_______________________________________________

 

Day telephone:______________________

Address_________________________________________

 

Evening telephone:_______________________

City____________________________________________

 

Zip Code:____________________

Email__________________________________________

 

Fax:_____________________________

 

(Indicate form of payment by checking box)  Credit Card:     ___Visa      ___Master Card    

 

 Card No.____________________________________    Expiration date______________________

 

Check – [Make checks payable to SCADA]                 

Cash

 

Thank you for supporting Democratic values