Hope for America Coalition

Thank you for your interest in joining the Hope for America Coalition. Please complete the following membership application.

Your Name*

Spouse Name

Address Line 1*

Address Line 2

City*

State*

Zip*

Day Phone

Cell Phone

E-mail*

Member Ship Level

	Student/Military: $25.00		Associate: $50.00
	Full Membership: $100.00		Other Amount -
	Family Full Membership: $150.00

Please make checks payable to "Hope for America Coalition PAC"
(NOTE: Donations made to Hope for American Coalition PAC and all 501(c)(4) political organizing groups are NOT tax deductible.)

Statement of Adherence to HFAC Principles
(Required for all Full Members - please electronically sign and date below)

I do solemnly affirm that I will faithfully support the guiding principles of the Hope for America Coalition, and will to the best of my ability, preserve, protect and defend the Constitution of the United States of America.

Signature
(Enter your name)

Date