MEMBERSHIP FORM

NAME____________________________

ADDRESS________________________

CITY/STATE/ZIP:__________________
_____________________ /___________

TELEPHONE______________________

E-MAIL___________________________


please check one:

_____ $50.00 Sustaining Level
Membership

_____ $30.00 Couples Membership
(2 persons at same address)

_____ $20.00 Basic Individual
Membership

_____ $10.00 Student / Low Income
Membership

Please send in this form with check TODAY!

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Mail to:
GLOBE
Post Office Box 56305
Hayward, CA 94545