OutPOCPAC Membership
__ Yes, I am an LGBTST Person of Color, living
in New York State, and I want to become
a Member of OutPOCPAC. Enclosed is my contribution of
$20 (fee can be waived upon request for limited income).
Members may fully participate in all OutPOCPAC activities
and meetings and may vote on endorsements and legislation
at club meetings.
__ Yes, I am not an LGBTST Person of Color but I am interested
in supporting OutPOCPAC and would like to become an Associate
Member. Enclosed is my contribution of $20. Associate
members may fully participate in all OutPOCPAC activities and
meetings but may not vote on endorsements and legislation at
club meetings.
Name: _______________________________________________________________
Address: _____________________________________________________________
____________________________________________________________________
____________________________________________________________________
Home Phone: ______________________ Work Phone: _______________________
Fax: ______________________________________________
E-mail: _______________________________________________________________
Enclosed: $______.__
Check the committee(s) you are interested in joining:
___ Membership
___ Candidate Questionnaire
___ Events/Forums
Your Signature: _____________________________________________________________
Please print and mail to:
Out People of Color Political Action Club
P.O. Box 1605, Madison Square Station
New York, NY 10159