Roots of Motive Power - Membership Form

Roots of Motive Power Membership and Donation Form
(web site)

Roots of Motive Power is a non-profit corporation under Sec. 501(c)3 of the IRS code; all donations are tax deductible to the extent allowed by law.

Name_____________________________________________________

Address___________________________________________________

City_______________________________ State_____ Zip__________

Phone # _________________ email _________________________

Membership Fee, 1 year (January - December), $35.00
(includes a subscription to the Newsletter)

$______

I wish to make an additional donation to Roots (please indicate if you would like your donation to go to a specific project):

__________________________________________________________		$_____
__________________________________________________________		$_____
__________________________________________________________		$_____

$______

Enclosed is my check for the total of:

$______

Make checks payable to: Roots of Motive Power, Inc.

Roots of Motive Power, Inc.
P. O. Box 1540
Willits, CA 95490-1540