Join CCIR!

Join CCIR!

Please print this, fill in the requested information and snail-mail with appropriate amount (check or money order only) to:

CALIFORNIA COALITION FOR IMMIGRATION REFORM
5942 Edinger Avenue, Suite 113-117
Huntington Beach, CA92649

NAME_______________________________________________

E-MAIL ADDRESS__________________________________________

MAILING ADDRESS_________________________________________CITY_______________________

STATE________________________ZIP___________COUNTRY_________________________

(Optional) TELEPHONE (_____)______________ FAX (_____)________________

MAY WE INCLUDE YOU ON OUR E-MAIL LIST? ___YES ___NO

MAY WE INCLUDE YOU ON OUR REGULAR MAILING LIST? ___YES ___NO

HOW OR WHERE DID YOU HEAR ABOUT CCIR?______________________________________________

CHOOSE MEMBERSHIP PLAN:

___U.S - (Minimum) $30.00
___U.S. - Sustaining $50.00
___U.S. - Benefactor $100.00

___Outside U.S. - Minimum $42.00
___Outside U.S. - Sustaining $67.00
___Outside U.S. - Benefactor $117.00

I AM ENCLOSING $_________(U.S.) ____CHECK ____MONEY ORDER

Thank you for supporting CCIR and America!