Illinois Gender Advocates
		Membership Application / Renewal
		First Name:________________________ Last Name: _________________________________
		MAILING LABEL: Name ______________________________________________________ Address_____________________________________________________ ____________________________________________________________ City______________________________State_____ Zip+4____________
		PHONES / E-MAIL: Home (_____ ) ___________________ Work (_____ ) ___________________ Fax (_____ ) ___________________ Other (Specify) ___________________ E-Mail ___________________
		Please indicate any special contact instructions, should we need to call or mail you. __________________________________________________
		MEMBERSHIP LEVEL (check one): (____) Student/Youth - $10 (____) Annual - $30 (____) Supporting - $100 (____) Benefactor - $250 (____) Other - $ ________
		How would you like to be involved with ITI? (____) Keep informed by newsletters (____) Participate in monthly meetings (____) Participate in youth group (ages 14-24) (____) Participate in actions (e.g. lobby, rally, leaflet) (____) Join a working group or committee. Which one? __________________________________________ (____) Liaison with other human rights groups. Please specify __________________________________________
		(____) Do you have any special skills which could help us out? (legal/legislative, artistic/design, technical/computer). Please specify ________________________ __________________________________________________________________
		Please note: We are a 501(c)(3) organization. All contributions in excess of the annual membership are tax deductible. Membership includes monthly newsletters and full participation in all IGA meetings and events. Make check or money order out to "Illinois Gender Advocates" and mail to:
				Attn: Membership Illinois Gender Advocates 47 W. Division St. #391 Chicago, IL 60610 For more info: Phone: (312) 409-5489 IGA@genderadvocates.org