ORGANIZATION MEMBERSHIP

NAME OF ORGANIZATION: _______________________________________________________

CONTACT PERSON: _____________________________________________________________

ADDRESS: ____________________________________________________________________

CITY: ________ STATE: ______________ Zip: ___________________

Phone No: ___________ Email: (Optional)_______

Web Site: (optional)________________________

We will be willing to support you by doing the following:

                                                                      YES       NO

Stamps                                                        _______    ______  

Copies                                                        _______    ______

Posters                                                       _______    ______                                    

Petition Drive                                             _______    ______

Funds                                                           _______    ______

Phone Contact                                             _______    ______  

Retrieving Stories from Internet                _______    ______

_____________________________                   _____________

Signature                                       Date                               

STOP CHILDREN SERVICE ABUSE OF POWER

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