MEMBERSHIP & VOLUNTEER
RESPONSE FORM

First Name:
Last Name:
Company/Organization:
Address:
City:
State:
ZIP/Postal Code:
Other Address Info:
(Country, etc.):
Telephone:
Fax:
E-Mail:


I am interested in being a coalition resource for the following areas (check all that apply)?

Language Rights Multicultural Events/Forums
Immigrant Rights Advocacy Workshops
Citizenship Advocacy Speakers Bureau
Bilingual Education Fundraising
MCAS & Other Education Issues Media Advocacy/Training
Community Organizing Computer Assistance
Legislative Advocacy Research Assistance

Sign up for an annual membership in the Mass English Plus Coalition?


TYPE OF MEMBERSHIP
No  I do not want to pay for membership (although I might volunteer).
Yes, Personal Sign me up for a Personal Membership in the Coalition. I am sending in a check for $25.00 to cover the costs of membership.
Yes, Organizational Sign up the whole Organization that I represent. I am sending in a check for $35.00 to cover the costs of membership.

Donate to the Mass English Plus Coalition?

No, I cannot donate at this time
Yes, I will be mailing in a $25.00 donation
Yes, I will be mailing in a $35.00 donation
Yes, I will be mailing in a $50.00 donation
Yes, I will be mailing in a $ donation



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