TAXPAYERS ASSOCIATION, INC.

Please print this page and mail to the address above.

MEMBERSHIP APPLICATION

Name: _________________________________________________________________

Address: ________________________________________________________________

City, State ZIP + 4: _______________________________________________________

Phone # (________) ______________________________________________________

Fax # (________) ________________________________________________________

E-mail address: __________________________________________________________

Areas of interest that you would like information: (Please Check (X) Answer)

Can you volunteer time or effort in various projects?
YES _____
NO _____

How would you like us to contact you?
E-mail _____
Telephone _____
FAX _____
U.S. Mail _____

Would you like to make a tax-deductible contribution?
YES _____
NO _____
If YES: Amount Enclosed: $________________

Occupation (If over $100.00): ________________________________________________

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