MEMBERSHIP FORM
Please print this page then complete the following information and mail it along with your check to:

Citizens Transportation Coalition of Collier County
386 Emerald Bay Circle, Naples FL 34110  Ph. (239) 254-0670

We need your help. Please support the printing, marketing and legal efforts of the CTC. Help us to continue our efforts to advocate safe and cost effective transportation approaches for the local area.

     2008 Membership: ____$25, ____$50, ____$100, ____$200, ____$1000

                  CTC is a citizen based, community action organization. 
                  Your personal information will not be sold or used for anything other than CTC contact purposes.

Please Print Clearly

*Name First____________________________ *Last  ___________________________________
Local Address

*Street _______________________________ *City ____________________*St ___ *Zip ___________

Phone ______  ______  ______      Cell ______  ______  ______

E-Mail _______________________________________@ ___________________________________

*List Employer or Retirement Status: __________________________________________________

Circle Level of Interest:  Supporter; Behind the Scenes;  Participate in Meetings & Rallies. 

Circle Skills / Interests:  Computer – Word,   Excel,   Web Design / Maintenance;   Fundraising:

Event Planning;  Public Speaking;  Research;   Writing;  Traffic Planning;   Environmental Knowledge;

Graphic Design;  Other: _______________________________________________________

Comments: ________________________________________________________________________

__________________________________________________________________________________
Summer Address

Street _______________________________ City ____________________St ___ Zip _____________

 2000 03 08