MEMBERSHIP APPLICATION
REMIT YOUR DUES
RENEW YOUR MEMBERSHIP
ON THIS FORM
TODAY!
I ENCLOSE MY DUES _$
_____________ DATE_________________
REGULAR MEMBER: $20
FAMILY $30
SUSTAINING MEMBER $35 and up**
REDUCED INCOME: $15
LOW INCOME $10*
* NO ONE IS DENIED MEMBERSHIP BECAUSE OF INABILITY TO PAY
** SUSTAINING CONTRIBUTIONS ARE USED TO SUPPLEMENT LOW-INCOME MEMBERS
ALL CONTRIBUTIONS TO GRAY PANTHERS ARE TAX DEDUCTIBLE
NAME:_______________________________________________________ _
ADDRESS:_____________________________________________________
TELEPHONE:____________________________
PLEASE MAKE CHECKS PAYABLE TO
GRAY PANTHERS OF METROPOLITAN WASHINGTON
755 EIGHTH STREET
NW
WASHINGTON, D.C.
20001
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