Information/Membership Form

Our strength depends on our numbers. You are the power that makes us effective. Members help us in electing anti-death penalty candidates as well as persuading elected officials to vote with us. We must keep Massachusetts among the handful of states opposing the death penalty, particularly now when so many people nationwide are pushing for a death penalty moratorium.

[Required information]

First Name		Last Name
Address
City		State		Zipcode
E-mail
Phone (Days)		Phone (Eve)
Yes, I want to help in the fight against the death penalty in Massachusetts.
	$40, General Membership $60, Household $30, Student/Fixed Income
Additional Donation:
	Please accept an additional donation in the name of
	$50
	$100
	$200
	$500
	Other: $
	Please send me information about joining MCADP.
	Please send me information about joining (or forming) a local Chapter.
Comments:
If you wish to send your donation by mail please print this form to include with your payment before you click the submit button. (Submit will take you to a PayPal option.)