|Please print out this form and send it to:
ATTN: Membership Services
88 Third Avenue, Suite 313
Brooklyn, NY 11217
Yes! I would like to make an automatic sustainer pledge to the New Party.
My monthly pledge is for:
__ $25 __ $20 __ $15 __ $10 __ Other $ _________
I will pay by:
____ Automatic bank draft. Please charge my monthly contribution to my bank
account as an automatic deduction. Enclosed is a check for my current month's pledge.
____ Credit Card. Please charge my monthly contribution on:
Visa/MasterCard/AmEx No.: ___________________________________ Exp.: _____
I'm honored to be a core supporter of the New Party, but I cannot commit to a monthly
amount at this time.
I am pleased to join at a rate of:
__ $250 __ $175 __ $100 __ $50 __ $36 (basic membership)
__ Other $ _________
City: State: Zip:
Daytime Phone: ( ) Evening Phone: ( )
(Your e-mail address will enable us to send you your membership confirmation
and other materials electronically, thus saving money and conserving resources.)
If you would prefer to pay by phone, please call 1-800-200-1294 weekdays
between 9 am and 6 pm, EST. We will be happy to take your membership information
over the phone.
Questions about your membership? Send a message to our membership services