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 - $20

 

___  Patron - $50

 

___  Organization - $100

 

Please mail the completed form to:

 

District of Columbia
Recovery Community Alliance
PO Box 42336
Washington, DC 20015