Please print this form, fill it out and mail it along with your check.

Member Information:

Name:__________________________________________

Address:_______________________________________

City:_________________ State:____ Zip:_________

Phone:_______________________________(optional)

E-Mail:______________________________(optional)

Amount Enclosed:

Online sign-up fee* (__ members x $15 each) $_____

Additional Contribution*                 $_____

                           CHECK TOTAL   $_____

Please Mail To:

Howard Jarvis Taxpayers Association
621 South Westmoreland Avenue, Suite 202
Los Angeles, CA 90005


* Membership dues and contributions to HJTA are not tax deductible for charitable purposes.