Name ___________________________________________
Address ________________________________________
________________________________________________
City ___________________________________________
State _____________ Zip ________________________
Phone __________________________________________
E-mail _________________________________________
Would you like to be added to our e-mail list?
_____ Yes _____ No
Membership rate:
_____ Individual: $20/year
_____ Family: $30/year
_____ Organization: $50/year
_____ One-time donation $__________
Please make checks out to "C4" and mail to:
C4
P.O. Box 183
Hobart, IN 46342-0183
Note: C4 is not a tax deductible organization.
Thank You!