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Membership PDF Print E-mail
Written by Bob Picard   
Friday, 03 October 2008

Constitution Party of Massachusetts

Membership application or donation submission

Please print this form using the PRINT or PDF function on the top right, and mail it to the address below.


I am in agreement with the Constitution Party Platform and wish to join with the Constitution Party of Massachusetts

Date:  __________

Name(s)__________________________________________

Address_____________________________________________

City / Town_____________________________________

County_________________________________ Zip____________


Occupation______________________________________

Congressional District____________________

Employer Name and Address:
_______________________________________________________________

Phone (Incl. Area Code):

Home: (____)_____________________

Work: (____)______________________

Email Address___________________________________________


Donation only: (one time) $______

Individual membership-Annual……………………….$25.00

Couple’s Membership-Annual………………………...$45.00

Family Membership (2 or more children)-Annual…….$65.00

Full-Student Membership-Annual……………………..$20.00

Senior Membership-Annual……………………………$20.00

I have changed___________, Will change__________, my voter registration to Constitution Party


Please make Check or Money Order payable to:

Constitution Party of Massachusetts
83 Turner Road
Townsend, Ma. 01469

Constitution Party of Massachusetts, Richard P. Selfridge, Chairman and acting Treasurer, Townsend, Massachusetts
E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it


Thank you for your interest in and support of a party that represents YOU,
a defender of the Constitution of the United States of America


(Please notify us if you are no longer interested in receiving our mailings. Thank you)

(Donations to political party are not tax deductible)

 

Last Updated ( Saturday, 20 June 2009 )
 
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