Constitution Association         

Connection Card      

Join the Effort to Restore Our Republic     

Become Active Now, Or Lose Your Country Later     

Date:  _______________________     

[___]  Add me to the Douglas V. Gibbs / Constitution Association Email List
                             [___]  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                                                                                                                                                                                                                                                                   
[___]  "I'm In" . . . Sign me up as a member right away.  Yearly dues are $25.
How do you want to pay?  
[___]  Cash    [___]  Check   [___]  Debit Card   [___]  Credit Card
You may chose to pay online by going to the Constitution Association Website.
  Please complete the following information     (please print clearly) 

   Name:    [__] Miss   [__] Ms   [__] Mr   [__] Mrs  ____________________________________________

Email:   _____________________________________________________________  Information Update: [__]

   Address:   _______________________________________________________________________________

   City / State / Zip:   _________________________________________________________________________

   Phone:  ____________________________________________________
  [__] Home   [__] Cell   [__] 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 is a Non-profit, organization, Incorporated July 2015.

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!

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



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