COALITION FOR A CONSERVATIVE MAJORITY
Denver Chapter

APPLICATION FOR MEMBERSHIP

NAME:   _________________________   _______  ___________________________
                          (First)                      (MI)                       (Last) 

ADDRESS: ______________________________________________________________
                                                 (No. & Street or P.O. Box) 

               ______________________________________  ____  __________________
                                     (City or town)               (St)           (ZIP)

TELEPHONE NOs: __________________________     ____________________________
                                        (primary)                 (backup - work or cell phone)

E-MAIL ADDRESS: ________________________________________________________

Primary Areas of Concern: (check all that apply)

___   Social/Cultural Issues ___   Media Issues
___   Economic Issues (fiscal/monetary policies, taxes) ___   Big Government
___   National Security/Military Issues ___   Education
___   Energy and the Environment ___   Gun Control
___   Other (specify) __________________________ ___   Gov't Transparency


Experience or special skills:  (check all that apply)

___   Political Activities (held office, campaigned, attend rallies/conventions, etc.)

___   Media Activities (letters to the editor, press releases, interviews/appearances)

___   Fund Raising

___   Public Speaking

___   Other (specify)_________________________________________________
Annual Dues: $52.00* (Not applicable to college students)  
____ Check here if college student     Name of school _____________________________

 

* The Coalition for a Conservative Majority is a nonprofit, nonpartisan education and advocacy organization under Section 501(c)(4) of the Internal Revenue Code. Contributions/dues are not tax deductible as charitable gifts.