Constitutional Organization Of Liberty

Membership Application

Name: _____________________________________________________________________

Address: ___________________________________________________________________

City/State/ZIP: ______________________________________________________________

E-mail: _____________________________________________________________________

[  ]  2009 Individual Membership - $15

[  ]  2009 Household Membership - $25

[  ]  I cannot participate in COOL at this time but have enclosed a contribution:

[  ]  $100    [  ]  $75     [  ]  $50     [  ]  $25     [  ]  Other
Please add my name to the mailing list for more information on:

[   ]  A More Perfect Union (half day course)

[   ]  Institute On The Constitution (mulit-week sessions)

To be completed for contributions in excess of $250:

Your occupation: _________________________________________________________________

Employer: ______________________________________________________________________

Constitutional Organization Of Liberty (COOL) is a registered Political Action Committee (PAC)
with the Commonwealth of Pennsylvania; contributions are not tax deductible.  Maximum contributions
of $25,000 per person, per year are allowed.  Corporate contributions are prohibited.
Sorry, we cannot accept corporate checks!

Make checks payable to:
Constitutional Organization of Liberty
P.O. Box 822
Lebanon, PA 17042
717-228-7524

The Constitutional Organization Of Liberty reserves the right to reject any applicant for membership or to terminate membership
for due cause as determined by the Executive Committee with a full refund of dues for the respective calendar year in which
termination occurs.

Paid for by Constitutional Organization Of Liberty - Monica Carpenter, Treasurer