Stonewall Democratic Club of Southern Nevada
P.O. Box 72858
Las Vegas NV 89170-2858


PLEASE PRINT EVERYTHING

Date:______________

Name:____________________________________________

Email Address:____________________________________________

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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