• Membership Application

Today's Date ____________________________________________________

Name __________________________________________________________

Street (or POB) __________________________________________________

City -- State -- Zip ________________________________________________

Phone (home) _______________________ (other) ______________________

E-mail _________________________________________________________

Contribution enclosed:       ___ New       ___ Renewal

            ___$36 Basic - Individual / Family            ___$15 Student / Low income

            ___$50 Supporter          ___$100 Advocate           ___$500 Life

            ___$36 PAJOLA Group Basic          ___$100 Including monthly use of space
                                 (Peace And Justice Organizations Linking Arms)

          When completed, please send your contribution along with this application to                                     Albuquerque Center for Peace and Justice, 202 Harvard SE, Albuquerque, NM 87106.

                        Please check address label for your membership expiration date.

ACPJ is a 501c3 organization and your donation, above the cost of membership, is fully tax-deductible.