CJPC 2006 Individual Membership Form

____ Yes, I would like to join (rejoin) the CJPC.

Name _________________________________________________________________

Address ________________________________________________________________

Email __________________________________

Phone __________________________________ Fax ________________________________

(Email addresses help us reduce mailing costs. Be assured that we will not share this information with any other organizations. Also, we will use your email address for the list serve if you wish to be removed from the list serve please let us know.)

Enclosed are my dues for 2006. Note that CJPC is a tax-exempt 501(c)3 charitable organization)

_____ $25 for an individual membership plus an additional contribution of:

_____ $50 _____ $100 _____ $200 _____ Other

Please make checks payable to the: Criminal Justice Policy Coalition

In order for us to be responsive to the wishes of our membership please respond to the following questions:

o Would you like to volunteer with the CJPC or participate on a committee?

o Would you be willing to testify or speak about Criminal Justice issues?

o Do you know of other places in your community that might like to host a speaker?

Your thoughts are welcome. Please feel free to provide them in the space below.

Collective Action for Humane, Healing and Effective Criminal Justice Policy

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

Thank You Very Much!

For More Information Contact:

Criminal Justice Policy Coalition
563 Massachusetts Avenue, Boston, MA 02118
Tel: 617-236-1188

Fax: 617-236-4399
Electronic Address: [email protected]