Illinois Gender Advocates

Mailing List Enrollment Form

CONTACT INFORMATION

Name: _____________________________________________________________________________

Home Address: ______________________________________________________________________

City: ________________________________________ State: ____________ ZIP Code: _____________

Home Telephone: _________________________Work Telephone: ______________________________

Mobile Telephone: ________________________ E-mail Address: _______________________________

I wish to be placed on Illinois Gender Advocates mailing list to receive newsletters and e-mail updates.
___________ Enclosed is a check for $30 to cover postage, handling and the cost of the monthly newsletters.

Please return completed form with a check for $30 made out to Illinois Gender Advocates to:
Attn: Mailing List
Illinois Gender Advocates
47 W. Division St., #391
Chicago, IL 60610

For additional information contact Rebecca Davis at RebeccaD@genderadvocates.org
OR CALL US AT 312-409-5489