(To print, click on "File" then "Print." Send form with your check to P.O Box listed below)
The information you fill in on this form will be kept securely on a computer that is not connected to the internet.
 
Please Note that we do not trade, buy or sell mailing lists and all information we receive is held in strict confidence.

Full Name: _________________________________________________

Address & Apartment: ________________________________________
City: _______________________________  State: ________________    Zip Code: _____________________

Phone (daytime): ________________________________     Phone (evening): ________________________________
Fax: ___________________________________________ 

E-Mail: _________________________________________(Please print carefully or send an email to: livablenewyork@erols.com with the word Subscribe in the Subject heading)

Company Name, etc.: _______________________________________

I wish to support the Coalition's efforts on behalf of the community.  My contribution is:
(   ) $1,000.00          (   ) $500.00          (   ) $250.00          (   ) $200.00   (   ) $100.00             (   ) $75.00            (   ) $50.00            (   ) $25.00 
(   )  other _________________

(   ) Annual Dues $25.00     (   ) Renew Dues     (    ) Pre-pay Dues

Please make checks payable to: CALW, Inc. - Write Challenge Grant in lower left-hand corner of check.
Mail  to: CALW, Inc., P.O. Box  230078, New York, N.Y. 10023.  All contributions are tax deductible [section 501c3]