MEMBERSHIP FORM

Join and support the National Coalition of Free Men (NCFM). Please print the following form. Fill it out, place it in an envelope and mail it in together with your check or money order. In a short time you will receive your newsletter, Transitions: Journal of Men's Perspectives.

In addition to men, NCFM welcomes the membership and participation of women who are interested in men's issues.

National Coalition of Free Men
PO Box 582023
Minneapolis, MN 55458-2023
---------Office...(516) 482-6378
The above telephone number is located in New York.
MN stands for Minnesota.

Please PRINT !!! Internet ID # for Electronic Mail____________________________________
You will automatically be placed on our e-mail discussion list. Simply notify us if you wish to
unsubscribe. Do NOT subscribe me___________

Check here to receive our monthly on-line newsletter___________


NAME __________________________________________________________ 

STREET ADDRESS (or Box #) _______________________________________ 

_______________________________________________________________ 

City __________________________________  State ____ Zip ____________ 

TELEPHONE NUMBER WITH AREA CODE: 
                            HOME: _________________________________ 

                            WORK: _________________________________ 

OTHER E-MAIL ID NUMBER:_______________________________________ 

OCCUPATION ___________________________________________________ 

MAKE CHECK OR MONEY ORDER PAYABLE TO:
        COALITION OF FREE MEN 

Enclosed is my check for: 

$30 _____ for one year's membership. 
CANADIAN RESIDENTS MUST SEND A U.S. MONEY ORDER.

$50 _____ Sustaining Member (One Year). Sustaining members are special patrons of Free Men. 

$40 ________ 1 YEAR for residents outside the USA or 
CANADA,  MUST SEND USA CURRENCY. 

I would like to support the Men's Resources Hotline:  $9 ______

I WOULD LIKE TO MAKE AN ADDITIONAL TAX DEDUCTIBLE DONATION: 
(please check one when you mail your check or money order) 

$10____ $25____ $50____ $100____ $500____ Other_______ 

The following questions are for computer users. They are 
part of a survey to determine member resources and are not 
being used for market research.


1)- What kind of computer do you have?


2)- If you have desktop publishing capabilities or advanced 
word processing capabilities, please describe:


3)- If you have data base management capabilities, please 
describe: 


4)- Do you use any other communication services besides the 
Internet (e.g., Prodigy, Compuserve, America On Line, etc.)? 
If yes, please list them along with your user address:


5)- Do you communicate with or operate a bulletin board (BBS)? 
If yes, please describe your activity.


6)- Do you have a fax number(s)? If yes, please note the hours of 
operation and if it is necessary to call first:


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The following are activities that NCFM seeks help with in 
order to maintain our organization. Please place a mark next 
to any that you would like to help with: 

Newsletter production(1)                   Graphic arts and brochures(2) 
Data management(3)                         Membership recruitment(4) 
Political action(5)                               Letter writing(6) 
Speaking at public policy hearings(7)     Research(8) 
Writing articles(9)                              Peer counselling/referrals(10) 
Chapter development(11)                   Legal advice/referrals(12) 
Informational research(13)                 Book keeping(14) 
Fund raising(15)                                 Grant writing(16) 
Running a discussion group(17)         Doing postings on Internet(18)

OTHER, please specify(19) 

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The following are activities and topics of special interest.
Please mark any in which you have an interest. Let us also
know if you would be interested in participating in a group
or leading a task force:

Abortion issues(a)                             Battered men(b) 
Divorce and Family Law(c)               Men and the Judicial System(d) 
Men and the Media(e)                      Sexist draft(f) 
Fathering issues(g)                           Male/female relationships(h) 
False accusation of sex harassment(i)    Child custody and men(j) 
Men and the Military(k)                     False Accusation of Rape(l) 
Sexual abuse of men(m)                   Sexual harassment(n) 
Violence against men (o)                   Circumcision (p)
OTHER, please specify(Q)


Please use any remaining space to tell us what some of your
interests and views are and to make any additional comments.
THANK YOU !!!