__ 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.
Home Phone: ______________________ Work Phone: _______________________
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