Name:
Address:
Address 2:
City:
Zip Code:
Telephone:
Fax:
Cell:
E-mail Address:
How Much is your Rent?:
Less than $800.00
$800.00-$900.00
$900.00-$1,100.00
$1,100.00-$1,300.00
$1,300.00-$1,500.00
$1,500.00-$1,700.00
$1,700.00-$1,900.00
$1,900.00 or more
I don't care to answer this one!
Would you be interested in learning more about Rent Control?:
Not Very Somewhat Quite Very
Would you be interested in helping to sign up new members?:
Not Very Somewhat Quite Very
Would you like to be informed of future events and activities?:
Yes No Maybe
Would you be interested in making a donation?:
Yes No Maybe
Comments: