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