We The People

Constitution Association, Inc.          

Connection Card      
  

Join the Effort to Restore Our Republic     

Become Active Now, Or Lose Your Country Later     



Date:  _______________________     

Membership Dues [Form Under Construction]

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                             [___]  I would like to get involved,  How can I help?                                                                                                                                                                                        
                             [___]  This is important, and I want to help.  Please send information on how I can help with monetary contributions.                                                              
                             [___]  My Group is interested in having Douglas V. Gibbs speak on the Constitution at one of our meetings.
   
                                                                                                                                                                                                                                                      

                           

  Please complete the following information     (please print clearly) 

   Name (include title):     _____________________________________________________________

  
 
Email:   _________________________________________________________________________________

   Address:   _______________________________________________________________________________

   City / State / Zip:   _________________________________________________________________________

   Phone:  _____________________________________________________________________ 
   [__] text ok?

Privacy Policy:  We respect your privacy.
Douglas V. Gibbs and the Constitution Association maintain a strict no sharing of personal information policy.
Your information is safe with us and will not be shared with any other third party.
The Constitution Association was Incorporated July 2015. (non-profit status pending)


How did you first hear about us:  [__] Internet   [__] Sign/Building   [__] Print Media   [__] Friend/Family   [__] Other


Other:  ___________________________________________________________________________________________________________________

Thank you for your interest.  We are excited to have you on board!

www.constitutionassociation.com       www.politicalpistachio.com

Please take a few minutes to tell us what your interests and skills are: ___________________________________________________________________

___________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________



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