Constitution Association, Inc.         

Connection Card      
Join the Effort to Restore Our Republic     

Become Active Now, Or Lose Your Country Later     

Date:  _______________________     

        [___]  "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
                             [___]  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.

                               [___]  Information Update,  I am already a member.

  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!

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



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