People First Membership Form

Please fill in your information below.

Membership fees are as follows:

Voting Members (Persons with a Disability) $10

Non-Voting Members (Persons without a Disability) $20

Fees will be billed to the address provided.

Thank You,

Kitsap People First Chapter

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* 1. Do you want to join Kitsap People First Chapter?

Yes

No

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* 2. Please select Voting Member or Non-Voting Member

Voting Member (Person with a disability)

Non-Voting Member

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* 3. Are you over the age of 18?

Yes

No

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* 4. What is your first name?

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* 5. What is your last name?

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* 6. What is your phone number?

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* 7. What is your mailing address?

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* 8. What is your email address?