Stonewall Democratic Club of Southern Nevada
P.O. Box 72858
Las Vegas NV 89170-2858
PLEASE PRINT EVERYTHING
Date:______________
Name:____________________________________________
Email Address:____________________________________________
*
Street Number:____________________________________________
City:_____________State:______________Zip:______________
*
Phone#:________________________
$20 [ ] Individual Yearly for SDCSN and National Stonewall Membership
$30 [ ] SDCSN, Nevada Stonewall Caucus, and National Stonewall Membership
$10 [ ] Student, Senior, Disabled
Print this page and send it with your check.
Thank you,
Stonewall Democrats of Southern Nevada
Membership Committee
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