Please fill out this page and print on any printer and mail it to us with your contribution.

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Coalition for Economic Survival    
514 Shatto Place, Suite 270
Los Angeles, California 90020
(213) 252-4411

 
You need not fill in all information, anonymous support is welcome.  However, in order for you to receive membership benefits such as our newsletter, we'll need to know how to contact you.
 
Here's my Annual CES Membership Dues:  

I want to be a CES Sustainer by pledging $                                                                       Monthly Quarterly
I've paid my dues, but here's an extra donation of $
Here's a donation of  $ to help support CES' important work.
 
Name:      Date of Birth:
Address:                    

Street:     State:      Zip:

Country:   

Telephone:  Day: -      Evening: -
EMAIL:
                           Please note, donations to CES are not Tax Deductible

We love to hear from our members, so please feel free to write comments on the remainder of the page. This will help us to better serve the needs of our community.

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          PRESS PRINT AND MAIL IN YOU MEMBERSHIP DUES WITH THIS FORM