To join the Connecticut Chapter of Americans United, please print the following form and return it with your check via postal mail to:

Connecticut Chapter

Americans United for Separation of Church and State

P. O. Box 210

Watertown, CT 06795

Please write "chapter 47" on your check.

Address ____________________________________________________

City ________________ State ______ Zip __________

Email _________________________________

Home phone____________________________

Work phone____________________________

Enclosed please find my contribution of:

_____ $25 _____ $50 _____ $100 _____ Other

Where did you hear about Americans United? _________________________________

I'd like to help with:

___ Speakers Bureau ___ Newsletter ___ Meetings ___ Mailings ___ Web site

Occupation: ___________________________________________________________

Return to membership.