| STONEWALL LIBERTARIANS PLEASE JOIN US |
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| YOU CAN ALSO COPY AND PASTE THIS FORM TO YOUR FAVORITE WORD PROCESSOR PROGRAM AND FILL IT OUT AND PRINT IT OUT, OR PRINT SCREEN THE FORM BELOW AND MAIL IT TO: Stonewall Libertarians, c/o Dr. Tom Stevens, 331 Willis Avenue, 2nd Floor, Mineola, NY 11501 Stonewall Libertarians Membership Application |
Stonewall Libertarians is an all-volunteer organization with members of all sexual orientations
and gender identities. We receive no government funding nor do we receive any money from the
Libertarian Party or any corporate entities. To function, we rely solely upon the generosity of our
members and those who donate money to help us in our organizational efforts.
The money we receive will be used to purchase booths at political conventions and at Pride
parades. We need money to purchase banners and to purchase ads in libertarian and libertarian-
leaning publications. We need to do internet advertising to reach out to those who might be
interested in what we are trying to achieve. I can promise you that every dime we receive will be
well spent to advance the purposes of this organization.
We have made great strides in the past couple of months and your financial support would be
greatly appreciated. We have the following three levels of dues-paying membership available:
• Sustaining Membership - $20.00 through 12/31/07. Allows you to be a full voting member of
the national organization and of any chartered chapter in your state.
• Chapter Life Membership - $200.00 makes you a voting Life Member of one designated
chapter at any one time for the remainder of your life.
• National Life Membership - $400.00 makes you a voting Life Member of the national
organization and of every chartered chapter of the Stonewall Libertarians for life.
If you prefer to donate money without becoming a member, please send your check or money
order made payable to “Stonewall Libertarians” c/o Dr. Tom Stevens, 331 Willis Avenue, 2nd
Floor, Mineola, NY 11501.
If you would like to join Stonewall Libertarians but are not in a position to donate money at this
time, you can join as a Basic Member, which is FREE. Basic members are non-voting national
members and are not considered members of any locally chartered chapter. Their involvement is
limited to participation on line.
You can obtain a copy of our latest Membership Application by clicking on the link to get an
adobe pdf file you can download, print out and mail back to the address indicated on it.
In the alternative, you can go to the Files Section of our Yahoo Group located at http://groups.
yahoo.com/group/Stonewall_Libertarians and download our Membership Application as a
Microsoft Word .doc document, which you can print out and return to the address indicated.
and gender identities. We receive no government funding nor do we receive any money from the
Libertarian Party or any corporate entities. To function, we rely solely upon the generosity of our
members and those who donate money to help us in our organizational efforts.
The money we receive will be used to purchase booths at political conventions and at Pride
parades. We need money to purchase banners and to purchase ads in libertarian and libertarian-
leaning publications. We need to do internet advertising to reach out to those who might be
interested in what we are trying to achieve. I can promise you that every dime we receive will be
well spent to advance the purposes of this organization.
We have made great strides in the past couple of months and your financial support would be
greatly appreciated. We have the following three levels of dues-paying membership available:
• Sustaining Membership - $20.00 through 12/31/07. Allows you to be a full voting member of
the national organization and of any chartered chapter in your state.
• Chapter Life Membership - $200.00 makes you a voting Life Member of one designated
chapter at any one time for the remainder of your life.
• National Life Membership - $400.00 makes you a voting Life Member of the national
organization and of every chartered chapter of the Stonewall Libertarians for life.
If you prefer to donate money without becoming a member, please send your check or money
order made payable to “Stonewall Libertarians” c/o Dr. Tom Stevens, 331 Willis Avenue, 2nd
Floor, Mineola, NY 11501.
If you would like to join Stonewall Libertarians but are not in a position to donate money at this
time, you can join as a Basic Member, which is FREE. Basic members are non-voting national
members and are not considered members of any locally chartered chapter. Their involvement is
limited to participation on line.
You can obtain a copy of our latest Membership Application by clicking on the link to get an
adobe pdf file you can download, print out and mail back to the address indicated on it.
In the alternative, you can go to the Files Section of our Yahoo Group located at http://groups.
yahoo.com/group/Stonewall_Libertarians and download our Membership Application as a
Microsoft Word .doc document, which you can print out and return to the address indicated.
Courtesy Title (Mr., Ms., Mrs., Dr.):________ E-Mail Address:___________________________________
First Name:_______________ Middle Name:_______________ Last Name:_________________________
Address:__________________________________ City_______________________ State_______________
Zip Code______________ Occupation_____________________ Cell Phone:_________________________
Home Phone (Optional):____________________ Business Phone (Optional):________________________
Date of Birth (Optional):___________________
Check all that apply (Optional): Gay_____ Lesbian_____ Straight_____ Bi-Sexual_____
Transgender_____ Questioning/Uncertain_____ Other______________________________
What talents, skills, contacts or resources are you willing to offer Stonewall Libertarians?
_________________________________________________________________________________________
What other G.L.B.T., LP or libertarian organizations are you currently a member of?
_________________________________________________________________________________________
Are you willing to take on a leadership role in Stonewall Libertarians? Yes_____ No_____
******************************************************************************************
BASIC MEMBERSHIP: FREE but involvement is limited to participation on line. Basic members are non-
voting national members and are not considered members of any locally chartered chapter.
SUSTAINING MEMBERSHIP: $20.00 through 12/31/07. Allows you to be a full voting member of the
national organization and of any chartered chapter in your state.
CHAPTER LIFE MEMBERSHIP: $200.00 makes you a voting Life Member of one designated chapter at
any one time for the remainder of your life. Please indicate which state (or Washington D.C.) chapter you
wish to designate at this time (if there is no chartered chapter in your area, your Life Membership will be
activated locally once a chapter has been formally chartered)_______________________________
NATIONAL LIFE MEMBERSHIP: $400.00 makes you a voting Life Member of the national organization
and of every chartered chapter of the Stonewall Libertarians for life.
******************************************************************************************
Please return this entire Membership Application with your check or money order made payable to
“Stonewall Libertarians” to Stonewall Libertarians, c/o Dr. Tom Stevens, 331 Willis Avenue, 2nd Floor,
Mineola, NY 11501. If you have any questions, e-mail Dr. Tom Stevens, the Founder of Stonewall
Libertarians, at DrTomStevens@aol.com or call him at 718-357-7075.