Yes!  I want to be a member of NJ Youth United Against War and Imperialism!

Name:                

Street Address:   |

City:                      State:    Zip:

Phone 1                 Phone 2   

E-Mail                

Other Organizations /
Websites                         

School (if any)     

Dues Donation (Suggested $5)   Or more of you can:

What are your top issues of concern?  What would I like to see this organization accomplish?  What skills would you like to offer?  How do you want to help?