new member form

New Member Form

Use this form to join the organization.

First name:

Last name:

Email address:

Postal address:

Line 1:
Line 2:
City:
State:	Zip:

Phone:

Email Communication. Please check one or more:

	I would like to receive the weekly eNews, an email newsletter emails incorporating progressive issues at the national and local level
	I would like to receive Action Alerts, as they are raised.
	I would like to receive only occasional emails announcing SCPA events

Volunteer.

The SCPA needs volunteers for all kinds of important work. If you have some time to devote to the progressive cause, please check some of these activities, or suggest your own.

	Outreach to or liaison with other groups Please list the groups:
	Writer
	Photographer/Videographer
	Web page creation/web programming (e.g., PHP)
	Speakers’ Bureau What topics?
	Policy research
	Telephone tree
	Event planning
	Anything!
	Other...

Comments:

Dues.

The activities of SCPA are supported by member dues and donations. Please join SCPA as a dues-paying member so we can continiue our work.

	Individual membership ($15)
	Family membership ($20)

If you are eager to be involved in the SCPA but are unable to pay dues at this time, please click here to contact us and submit this form (fill out the form and click the Submit button below.)

Note: SCPA dues are not tax-deductible at this time.

Donations.

Help advance the progressive cause.

Amount of donation: $10 $25 $50 $100 Other:

Pay dues by check:

Make your check out to: Space Coast Progressive Alliance, Inc.
Mail payment to SCPA postal address (see below)

Pay dues online:

After submitting this form, click on "Pay Dues Online".

Our address:

Space Coast Progressive Alliance
P.O. Box 412
Melbourne, FL 32902-0412

To submit this form, type the contents of this image:

into this field: then click on Submit: