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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

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Updated: 6/17/2001