CITIZENS FOR A LIVEABLE 210
Membership Form


Print out and complete this form, and mail it along with your contribution to
CFAL 210, c/o Phil Jones, Treasurer, 1520 Laurel Drive, Accokeek MD 20607.

Name______________________________________________

Address___________________________________________

__________________________________________________

phone____________________

fax______________________

e-mail____________________________________________

There will be some expenses involved in copying, mailing, etc., for this effort, so a contribution is suggested:

____ $10.00

____ other

Make checks payable to: CFAL 210 (Citizens for a Liveable 210).

How I Can Help (check all that apply)

Administration/organization_____

Preparing Mailings_____

Letter Writing_____

Phone Calls____

Public speaking,

lobbying____

Environment research____

Publicity____

Signs - making, hanging, distribution____

Leaflet distribution_____

Fund-raising____

other___________