(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): ________________________________
E-Mail: _________________________________________(Please print carefully or send an email to: email@example.com with the word Subscribe in the Subject heading) If your company has a Matching Gift program, please apply on behalf of the Coalition.
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]
We have no paid staff. We are all volunteers.
If you would like to help
( ) I can help with publicity.
( ) I can attend meetings, hearings etc.
( ) I can help with: __________________________________________________________
Are you affiliated with any groups that you think we should know about? If so, please list their names and any useful information, such as phone numbers, e-mail, website, etc..