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CENTRAL BROOKLYN INDEPENDENT DEMOCRATS

Join CBID


Please print the following form, fill it in, and mail it with your check. Thank you.


ANNUAL DUES

Check one:

(  ) $15 for one member, or

(  ) $25 for 2 or more members in same household, or

(  ) $10 for senior, student, or low income

Yes! I want to join CBID!
You'll be getting my check in the mail.


Name(s)____________________________________________________________

       ____________________________________________________________

Address____________________________________________Apt__________

City_______________________________________________State________

Zip Code_______________

Home phone____________________________

Cell phone____________________________

Work phone____________________________

E-mail address__________________________________________________


Dues should be snail mailed to:

Marty Bernstein
Treasurer, CBID
476 10th Street
Brooklyn, NY 11215


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