Membership Form-Please print this page and mail

BECOME A MEMBER OF NORTH PALM BEACH COUNTY NOW   CHAPTER #FL0355

(FREE OF CHARGE)

I am currently a member of NOW. My current status is:

___ I am a member at-large, or member of the former West Palm Beach Chapter.

___ I am a member of the____________________ chapter

Name: __________________________________________________

Address: ________________________________________________

City, State, Zip: ___________________________________________

Is this a new address? Y_____N____

Phone: __________________ Email: __________________________

Member ID number (if possible)________________ Expiration Date___________

Please accept this as notice of my desire to change my membership to the North Palm Beach County NOW Chapter.

___________________________________ _______________
Signature Date

Send to: North Palm Beach County NOW c/o Shirley Y. Herman, Treasurer
2600 North Flagler Drive #207
West Palm Beach, FL 33407

Thank you for your support. You will receive materials from the National organization eventually.