PAC*SJ Printable Membership Form

Please print this form and include it with your membership check to Join or Renew .  Member levels of $100 or more recieve a free copy of our Valley of Heart's Delight video.

Membership Type:

Individual $35 Family $50 Senior (over 65) $20 Student $20 School $25 Non-Profit $25 Contributor $100 Small Business $100 Corporation/Patron $250 Benefactor $1,000

Name
Street
Apt./Ste.
City
State
ZIP Code	-
Day Phone	- - x
Other Phone	- - x
E-Mail
Organization
Referred By:

Email me about upcoming events? Yes    No

PAC*SJ will not release your contact details to third parties without your consent. Please check if would like us to not publicize your name as a PAC*SJ member.

I would be interested in Volunteering (please check any of the following):       Serving as a Board Member       Working at events or tours       Testifying at public meetings       Writing articles for the Newsletter       Pro bono legal assistance       Public Relations     Other:

I would be interested in serving on:       Advocacy Committee       Fundraising Committee       Education Committee       Membership Committee

Mail this form and your membership check to:
PAC*SJ P.O. Box 2287 San Jose,CA 95109-2287
OR call us at (408) 998-8105 and give us your credit card details over the phone: we take Visa, MC and American Express.
PAC*SJ is a 501(c) 3 non-profit organization Non-Profit Tax ID:  77-0254542