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.
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?
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.
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!
www.constitutionassociation.com www.politicalpistachio.com
Please take a few minutes to tell us what your interests and skills are: ___________________________________________________________________
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Note: You only need to print the 1st page