Membership 2021 Membership Renewal

Use the form below. If you have any questions about your membership, check with Executive Director Jon Fuhrman at jon_fuhrman@outlook.com or 626 864-5255. I'd like to

join both groups for one low price! (Checks payable to ACT/ADC) 

$40 Single 

$70 Single Sustaining 

$25 Each additional member per household 

$90 Double Sustaining 

$15 Student or limited income 

$150 Patron

 $275 Benefactor I'd like to join ACT (Checks payable to ACT) 

$35 Single 

$60 Single Sustaining

 $20 Each additional member per household 

$85 Double Sustaining 

$15 Student or limited income 

$125 Patron  $20 Gift Membership (NEW!) 

$275 Benefactor I'd like to join the Arroyo Democratic Club (Checks payable to ADC) 

$35 Single 

$60 Single Sustaining 

$20 Each additional member per household 

$85 Double Sustaining 

$15 Student or limited income 

$125 Patron 

$275 Benefactor

Extra Contribution  $

___________ Political Account (for endorsed candidates and issues) 

$ ___________ Operating Account (for organizational costs)

$ __________ Total enclosed

Name

Home Phone

Address Office Phone City ZIP Email address

Mail to ACT, P. O. Box 40074, Pasadena, CA 91114-7074 Information you provide will be available to other members and endorsed candidates upon request.