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Please print out this form and send it to:

New Party
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 $ _________

Street Address:

City:               State:         Zip:

Daytime Phone: (   )                 Evening Phone: (   )

E-mail Address:

(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 coordinator:

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A Fair Economy.
A Real Democracy.
A New Party.

88 Third Avenue, Suite 313
Brooklyn, NY 11217
phone: 1-800-200-1294

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