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Please complete this form and mail to:
National Coalition of Free Men
PO Box 582023
Minneapolis, MN 55458-2023
Phone (516) 482-6378
Please PRINT
NAME __________________________________________________________
STREET ADDRESS (or Box #) _______________________________________
_______________________________________________________________
City __________________________________ State ____ Zip ____________
TELEPHONE NUMBER WITH AREA CODE:
HOME: _________________________________
WORK: _________________________________
EMAIL ADDRESS:_______________________________________
OCCUPATION (OPTIONAL) ___________________________________________________
You will automatically be placed on our email discussion list. Or, if you prefer not to be on our email discussion list, please check here:
Do NOT subscribe me___________
Check here to receive our monthly on-line newsletter___________
MAKE CHECK OR MONEY ORDER PAYABLE TO:
COALITION OF FREE MEN
Enclosed is my check for:
$30 _____ for one year's membership.
CANADIAN RESIDENTS MUST SEND A U.S. MONEY ORDER.
$50 _____ Sustaining Member (One Year). Sustaining members are special patrons of Free Men.
$40 ________ 1 YEAR for residents outside the USA or
CANADA, MUST SEND USA CURRENCY.
In addition, I would like to join the following chapter(s) of NCFM:
$10 __________ NCFM Los Angeles Chapter
$15 __________ NCFM Dallas-Fort Worth Chapter
$20 __________ NCFM San Diego Chapter
$10 __________ NCFM Twin Cities (MN) Chapter
I would like to support the Men's Resources Hotline: $ ______
I WOULD LIKE TO MAKE AN ADDITIONAL TAX DEDUCTIBLE DONATION:
(please check one when you mail your check or money order)
$10____ $25____ $50____ $100____ $500____ Other_______
TOTAL ENCLOSED $______________________
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The following are activities that NCFM seeks help with in
order to maintain our organization. Please place a mark next
to any that you would like to help with:
Newsletter production(1) Graphic arts and brochures(2)
Data management(3) Membership recruitment(4)
Political action(5) Letter writing(6)
Speaking at public policy hearings(7) Research(8)
Writing articles(9) Peer counselling/referrals(10)
Chapter development(11) Legal advice/referrals(12)
Informational research(13) Book keeping(14)
Fund raising(15) Grant writing(16)
Running a discussion group(17) Doing postings on Internet(18)
OTHER, please specify(19)
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The following are activities and topics of special interest.
Please mark any in which you have an interest. Let us also
know if you would be interested in participating in a group
or leading a task force:
Abortion issues(a) Battered men(b)
Divorce and Family Law(c) Men and the Judicial System(d)
Men and the Media(e) Sexist draft(f)
Fathering issues(g) Male/female relationships(h)
False accusation of sex harassment(i) Child custody and men(j)
Men and the Military(k) False Accusation of Rape(l)
Sexual abuse of men(m) Sexual harassment(n)
Violence against men (o) Circumcision (p)
OTHER, please specify(Q)
Please use any remaining space to tell us what some of your
interests and views are and to make any additional comments.
THANK YOU !!!
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