Join Form

Join CES

Please fill out this page and print on any printer and mail it to us with your contribution.

Coalition for Economic Survival
14320 Ventura Blvd. - PMB 537
Sherman Oaks, CA 91423
(213)252-4411

You need not fill in all information, anonymous support is welcome. However, in order for you to receive membership benefits such as our newsletter, we'll need to know how to contact you.

Here's my Annual CES Membership Dues:

I want to be a CES Sustainer by pledging $ Monthly Quarterly

I've paid my dues, but here's an extra donation of $

Here's a donation of $ to help support CES' important work.

Name: Date of Birth:

Address:

Street: State: Zip:

City:

Telephone: Day: - Evening: -

EMAIL:

Please note, donations to CES are not Tax Deductible

We love to hear from our members, so please feel free to write comments on the remainder of the page. This will help us to better serve the needs of our community.

NOW YOU ARE DONE!

PRESS PRINT AND MAIL IN YOUR MEMBERSHIP DUES WITH THIS FORM