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New Membership Application

The Jefferson Center is a non-profit corporation under section 501(c)3 of the Internal Revenue Code. All contributions to The Center are tax-deductible.

Dues and donations are used to support the programs of The Jefferson Center and to share our vision of a more tolerant, thoughtful, and secular world.

To join—and receive full membership benefits in The Jefferson Center—just print out this page and fill out the form below.

Single person:
□ $59 payable in December for the next year.
□ OR if you join mid-year, pay the pro-rated amount per start of the next month.

Family:
□ $99 payable in December for the next year.
□ OR if you join mid-year, pay the pro-rated amount per start of the next month.

Tom's Fund Donation: $____________

Total Enclosed: $____________

[Please print]
Name __________________________________________________________

Address ________________________________________________________

City __________________________________State ______ Zip ____________

Day Phone (________)__________________________

E-mail _______________________________________

Desired website account name _______________________________________

Make check payable to The Jefferson Center.
Mail printed form and check to: Jefferson Center Membership, 208 Oak Street, Suite 101, Ashland OR 97520