* Organization:
Executive Director:
Contact Person:
Address 1:
Address 2:
City:
State:
Zip:
Phone:
Fax:
* Email:
How did you hear about One Connecticut?:

Our Organization will do the following to help:

Testify at public hearings  Host educational sessions for our members  Activate members for events (rallies, public hearings, etc)  Organize grassroots lobbying  Organize letters to the editor  Include information about these issues in our newsletter and/or Web page.

Our Organization will contribute to One Connecticut

One Connecticut is a Coalition of Organizations. We welcome individual supporters interested in participating in the Coalition. Individuals receive emailings about critical issues affecting our community and participate in activities but do not vote at Member Meetings.

Membership Dues

Organization's Budget	One Connecticut Dues
Under $10,000	$25
$10,000-$100,000	$50
$101,000-$200,000	$100
$201,000-$300,000	$150
Over $300,000	$200
Individual Contributions
Low-income Individual	$5
Individual	$25

Of course, we welcome additional contributions. Your contribution is tax deductible to the extent allowable by law. Please send your check to:

One Connecticut
PO Box 261296
Hartford, CT 06126-1296