Belmont Citizens Forum

Request Newsletter

Please print out this form and mail it to:

Belmont Citizens Forum
P.O. Box 609, Belmont, MA 02478

___ Yes, send me the Belmont Citizens Forum newsletter.
- ___ Send me a sample copy.
- ___ Put my name on the mailing list
___I can donate the following amount to help pay for production and postage. (Please make checks payable to: Belmont Citizens Forum)
- ___ $50
- ___ $100
- ___ $250
- ___ Other
Please provide the following contact information:
Name _______________________________________________________
Title ________________________________________________________
Organization _________________________________________________
Street Address _______________________________________________
______________________________________________________________
City, State __________________________________________________
Work Phone ___________________________________________________
Home Phone ___________________________________________________
Email ________________________________________________________

Your contributions are tax deductible to the full extent allowed by law. The Belmont Citizens Forum is a 501(c)(3) charitable organization under the Internal Revenue Code.