Northwest Bronx
for Change

Concerned Citizens for Change is a grassroots organization working to advance progressive issues at the city, state and federal levels.  

Membership Form

Get Involved!!

Join Concerned Citizens

 Please print out and mail this form to the address below 


Name________________________________________________________________________Date_____________________________


E-mail(s) _______________________________________________________________________________________________________


Address _______________________________________________________________________________________________________


City _________________________________________________ State _________________________ Zip ______________________


Home Phone ______________________________________________ Cell ______________________________________________

______   $25 Individual Membership per year

______   Students, Disability, Unemployed, etc--pay what you can-- sliding scale starting at $10.00

______   $ 40 Couple’s Membership per year


Thank you for joining! 
Your membership dues will help support our programs and events throughout the year.

Please mail this form along with your check or money order to:  
Concerned Citizens For Change, 5900 Arlington Avenue, Apt 9C, Bronx, New York 10471. 

For questions, please e-mail us at: ccfcny@gmail.com
  

 

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