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