MEMBERSHIP APPLICATION

PLEASE PRINT CLEARLY


One year membership:         $20.00 (per person)

Additional Donation:              $_______________

Name(s):    _________________________     Phone: _______________     E-Mail: ____________________

                     _________________________     Phone: _______________     E-Mail: ____________________

Address:     ____________________________________ City: _________________  State: _______________

MAKE CHECKS PAYABLE TO C4QPE OR THE COALITION FOR QUALITY PUBLIC EDUCATION.

C4QPE IS A 501(C)(3) ORGANIZATION, SO YOUR CONTRIBUTION IS TAX DEDUCTIBLE.

PLEASE MAIL TO:  C4QPE, 6017 Pine Ridge Road #111, Naples, FL 34119

or 

PAY YOUR DUES ON PAYPAL


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