Membership Form

 

Please complete the fields below, then print and return with payment to:
Women Defenders
1010 Grayson Street, Ste. 1
Berkeley, CA 94710

 
Name:
Firm/Public Defender Office:
Profession, if not attorney:
Street Address:
City: State: Zip:
Contact Phone Number(s):
Email:
Fax:
 

Enclosed is my dues check for:
$200.00 Sponsor Membership
$100.00 Sustainer Membership
$60.00 Regular Membership
$25.00 Student Membership

I am unable to join Women Defenders at this time but would like to contribute: $