Membership Application
Name:_________________________________________________________________
Address:_______________________________________________________________
City:__________________________________________
State:__________________
Zip:___________________
Phone:_______________________________________
e-mail:_________________________________________________________________
[ ] $20 Membership
[ ] Additional donation _________
[ ] $35 Family Membership
[ ] I wish to become a member, but I do not wish to donate at
this time
(I understand that this trial
membership is for a three-month period)
Member fees are due at the beginning of the every calendar
year.
Member benefits include voting privileges during Coalition meetings and
eligibility
for committee participation and leadership.
Please print out and mail with your check payable to:
The Wallingford Coalition for Unity
200 North Main Street
Wallingford, CT 06492
203-265-6754
