Membership
Registration Form

Please print legibly and fill in all *required fields

Name:*

Address:*

Apt #:

City:*

State:*

Zip Code:*

Ward:

Home Phone:* (    )

Cell Phone: (    )

Work Phone: (    )

Email Address:

Which committee would you like to join?

___ Governance    ___ Events    ___ Policy

All DCRCA members are asked to pay yearly dues.

Please check appropriate box:

___ Individual - $12

___  Patron - $50

___  Organization - $100

Please mail the completed form to:

District of Columbia
Recovery Community Alliance
613 Second Street N.E.
Washington, DC 20002