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  Membership Form

 

First Name Last Name  
 
     
Address City State Zip
       
Primary Contact Number Secondary Contact Number Email  
 
       
Existing Member?      
     
       
 
Annual Membership Type - Due Annually by October 5th
 
Adult - $45
Youth (18 and under) - FREE
Business (1-20 Employees) - $150
Business (20+ Employees) - $250
     
 
Lifetime Membership
 
Adult - $500
Business (1-20 Employees) - $1,500
Business (20+ Employees) - $5,000
     
 
Lifetime Membership
 
   
Are you an active member in other organizations? Y/N - If Yes, please name all affiliations?
 
Are you available to volunteer on a monthly basis? Y/N - If No, list availability
 
Please list all skills that will help further the cause of The Peace Coalition
 
 
 

 

 

  
 


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