Highlands Peace Action Membership Form Please print out form and mail to Highlands Peace Action, 45 Ferris Lane, Oak Ridge, NJ 07438 Date:___________________
Last Name:_______________________________
First Name, Middle Name, or Initial ____________________________
Address Line 1____________________________________
Address Line 2____________________________________
City, State, Zip __________________________________________________________________
Home Phone_________________ Work Phone__________________ Ext. __________
E-Mail Address __________________________________________________________
Membership Options (circle one)
Membership – $10 Sponsor – $25 Donor – $50 Other – ____________
Note: We will not deny membership to anyone unable to pay membership fees.
Primary reason for joining Highlands Peace Action – _________________________________________________________________
_________________________________________________________________
Indicate activities you would be willing to participate in.
____ Vigils in West Milford
____ Attend monthly meetings
____ Phone banking
____ Film series
____ Assisting in Music Festival promotion.
____ Assisting in Music Festival activities (we need numerous volunteers for our Aug. 6th event.
____ Other_____________________________________________________________________Indicate personal skills or interests ______________________________________________________________________________
Make checks payable to Highlands Peace Action, and mail to:
Highlands Peace Action
45 Ferris Lane
Oak Ridge, NJ 07438-9157
Highlands Peace Action is an affiliate of New Jersey Peace Action and we encourage our members to become dues-paying, active members of that organization.
New Jersey Peace Action
673 Bloomfield Avenue, 2nd Floor
Bloomfield, NJ 07003
(973) 744-3263
www.njpeaceaction.org