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NORML Membership Form

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					                                                            Working to Reform Marijuana Laws

NORML Membership Form
“We need your help to end marijuana prohibition once and for all.”
                                            ~Willie Nelson

Join NORML supporters Woody Harrelson, Mark Stepnoski, Rick Steves, and Willie Nelson to
help end marijuana prohibition.

Benefits of membership are outlined below.

           $25                       $35                        $50                         $75
          Basic                    Regular               Citizen Advocate                Motivated
                                   Lapel Pin                Classic Logo               2 NORML Logo
                                                                                          Coasters

    Sorry, no gift,
   everything goes
  to change the law




         sticker


         $100                       $150                    $250 or more                   $2500
       Dedicated                   Devoted                    Big Time                    Lifetime
                                                            Select any gift,           Select any gift,
    Hemp Day Pack           NORML Logo Ashtray
                                                                 plus                        plus




                                                          NORML Education            NORML Education
                                                               Set                        Set




        lapel pin

*The NORML Education Set is: Grass The Movie DVD, and Citizen's Guide to Understanding America's Marijuana Laws, and
Emerging Clinical Applications for Cannabis & Cannabinoids.




               The National Organization for the Reform of Marijuana Laws (www.norml.org)

                                                                                                                4/29/2009
                                               Working to Reform Marijuana Laws
Fill out this form and mail to:                     Or fax to: (202) 483-0057
NORML
1600 K Street NW, Suite 501                         Please make check or money order
Washington, DC 20006-2832                           payable to NORML.

√   Membership         Price      Thank you gift       Indicate size/gift, if desired
    Basic              $25
    Regular            $35        Lapel Pin            __   None   __ Lapel Pin
    Citizen Advocate   $50        Classic Logo         __   None   __ S __M __L __ XL
    Motivated          $75        2 Coasters           __   None   __ Coasters
    Dedicated          $100       Hemp Day Pack        __   None   __ Hemp Day Pack
    Devoted            $150       Crystal Ashtray      __   None   __ Ashtray
    Big Time           $250       Education Set        __   None   __Education Set (also select any gift…
    Lifetime           $2500      Education Set        __   None   __Education Set …if you would like)

Total Amount: $__________

___ Make this amount a monthly pledge
___ Check here for membership renewal

Name ___________________________             Billing Address (if different)

Address ___________________________          Name ___________________________

City ___________________________             Address ___________________________

State __________________                     City __________________

Zip ____________                             State __________________

APO/AE ____________                          Zip ____________

Country ________________________             __ Visa     __ MasterCard        __ AMEX __ Discover

Email ________________________               Card number ________________________

Phone ______________                         Expiration date _____(month) _____(year)

Fax ______________                           ___ Check or Money Order payable to NORML


___ Make a tax-deductible contribution to the NORML Foundation. Donations to NORML can
be used for lobbying and, therefore, are not tax-deductible, where gifts to the NORML
Foundation are restricted to educational and legal projects and are deductible.




           The National Organization for the Reform of Marijuana Laws (www.norml.org)

                                                                                                 4/29/2009

				
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