And Justice for All

Membership Registration Form

____ $100 - Sustaining Membership

____ $20 - Regular Membership

____ $5 - Limited Income Membership

____ $1 - Student Membership

$______ - Additional Contribution


Name: ____________________________________________

Address: _________________________________________

City: _______________ State: ______ Zip: _________

Work Phone: ____________________

Home Phone: ____________________

Fax Phone: ____________________

Internet: ______________________________________

WWW Page: ______________________________________

Are you currently enrolled as a student? _________

If yes, where? ___________________________________

We are constantly looking for people who might be interested in supporting our efforts (both financially and politically). If you know of someone who might be interested, please give us an address and we would be happy to get in touch.

Name: ____________________________________________

Address: _________________________________________

City: _______________ State: ______ Zip: _________

Internet: ________________________________________

Checks (and money orders) should be made payable to And Justice for All and should be mailed to the following address:

P.O. Box 53079
Washington, DC 20009

Contributions to And Justice for All are not tax deductible and may be used to advocate the election or defeat of candidates for federal office.

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This page is maintained by Amar Chaudhary. Last update: 1/24/96