MEMBERSHIP FORM (  ) Stonewall Membership $25 (  ) Stonewall Couple $45 (  ) Student $20 Name___________________________ Address: ________________________ City_________________Zip: ________ E-Mail: _________________________ Phone (      ) _____________________ Occupation: _____________________per FPPC Employer: _______________________per FPPC Mail to: ICSD, PO Box 9642, Redlands, Ca. 92375 * $10 of every Membership goes towards your Membership in the National Stonewall Democrats. You will automatically become a NSD Member unless you request not to. ICSD is a grassroots, locally run Democratic political club. Thank you for your support! POLITICAL ID # 980833