Name:_______________________________
Address:_________________________Apt#:__________
City:_______________________State:_______Zip:_________
Home Phone: _______________
Work Phone: _______________
Preferred Fax Number: _______________
Preferred E-mail Address: ________________
Membership in S.T.O.P. is tax-deductible and starts at $25.00. Additional funds support S.T.O.P. programs. Membership for victims and their family members is free.
Please make checks payable to: S.T.O.P. - Safe Tables Our Priority. Amount enclosed:
____$25 ____$50 ____$100 ____$250 ____$500 ____$ other
I am also interested in contributing my time specifically to some of the following efforts (check any or all that apply):
- Website/internet development/maintenance
- Sharing my identified foodborne illness story with the press
- Back office assistance/data entry
- Gathering information at meetings in Washington, D.C.
- Gathering information at regional meetings held by government in my area
- Gathering information at meetings in my state's capital
- Other areas of expertise I can offer:
- ______________________________
Signature____________________________Date______________
The above signed understands that membership in S.T.O.P. is annual and non-voting.
We appreciate your support. Please share this information with a friend. We won't S.T.O.P. until safe tables are a reality!
S.T.O.P.
P.O. Box 4352
Burlington, VT 05406