COALITION FOR EQUAL PAY

To become part of the Coalition for Equal Pay please print this page, and send the completed form to the address below.

If you have questions, please call or email us. (You can be on our mailing list without becoming a formal Coalition member
at this time.)

Name of Group/Agency/Individual ____________________________________________________________________

Name & Title of Organization's Representative ___________________________________________________________

Address (of Representative) __________________________________________________________________________

____________________________________________Email address _________________________________________

Telephone(s) ________________________________________________Fax (if any)_____________________________

Date _____________________ Donation enclosed $_________________ (or not at this time____________________)

COALITION FOR EQUAL PAY
c/o Esther Peralez-Dieckmann
70 W. Hedding Street, 11th Floor
San Jose CA 95110