Name: ________________________________________________________________________

Street Address: _________________________________________________________________

City: ________________________________________ Zip Code:_______________________

Home Phone: _______________________ Office / Mobile Phone:________________________

Email address: _________________________________________________________________

Would you like to be on the WakeUP Wake County email list to receive announcements and information? ______ Yes

How you can help?

* Volunteer your time: Number of hours / month? _________
Areas of Interest:
______ administrative support
______ fundraising
______ assist in organizing forums & meetings

Join other members working on selected issues:
_____ education                                   ______transportation
_____ environment/energy                     ______open space /parks
_____ urban planning/development         ______communications/media

Please share any experiences (if any) you've had in the above areas (use back if needed):

____________________________________________________________________________________

____________________________________________________________________________________

*Please consider sending a tax-deductible contribution to WakeUP Wake County:*

Please make checks payable to WakeUp Wake County:
___$25 (membership dues) __$50 __$100 ___Other

Please send your completed form and any donations to:
WakeUP Wake County
PO Box 6484
Raleigh NC 27628-6484

WakeUP Wake County is a non-partisan, non-profit organization. Donations are tax deductible.