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 ______________________________________________
______ $35 Individual Membership per year
______ Students, Disability, Unemployed, etc--pay what you can-- sliding scale starting at $10.00
______ $ 60 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: [email protected]
BE A MEMBER!
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