Name:  ________________________________________

Religious Affiliation (optional):  _______________________

Clergy:  ________      Lay:  ________

Address:  ______________________________________

_____________________________________________

Phone:  _______________________________

Email:  _______________________________

Members of Clergy and Laity United for Justice and Peace (CLJP) are asked to contribute $60 annually (more if you can afford it, less if you cannot!).

Please make your check payable to Clergy and Laity United, and either give to Taylor Beard, Treasurer, or mail to him at 412 Westmoreland Court, Charlottesville, VA 22901-1243.

CLU anticipates being a 501(C)4 Organization; contributions are currently not tax deductible.

Amount___________