Membership Form

Please use this form to become a member of CPJ.
This form can also be used to update membership information.

PLEASE DO NOT SEND THIS FORM VIA E-MAIL.
Please print out this form and fax or mail it to CPJ at the address listed below.


I wish to join as an individual member:

Friend $5,000

Benefactor

$1,000

Supporter

$500

Contributor

$100

Participant

$45

Student

$20 (student ID)

All donors and members receive CPJ's biannual magazine, Dangerous Assignments, and our e-mail newsletter, CPJ Update.



I would like to:

Become a new member.

 

Update my membership information.



Prefix (Mr/Mrs/Ms):

First Name:

M.I.

Last Name:

Suffix (Jr.,Esq.):



  Institution


  Title


  Street

 

  City

State

  Zip / Postal

         Country


  Phone

 E-Mail

I would like to receive e-mail alerts from the following regions (please select a maximum of THREE; each selection will generate approximately five to 10 e-mails per month). Click on the regions below to preview the CPJ home page for each one, and which countries comprise that region.

Africa (sub-Saharan)

Americas

Asia

Europe and Central Asia

North Africa/Middle East

Payment Information

Enclosed, please find my check in the amount of US$,
or charge my credit card US$ as tax-deductible payment for my membership in CPJ.

Visa   MasterCard   American Express   Check

Card Number Expiration Date


Name On Card


_________________________________________________________________________
Signature


Please make check or money order payable to Committee to Protect Journalists. Funds must be paid in US$ and drawn on a U.S. bank or U.S. resident branch. This form can also be used to update membership information. Mail this form to:

Director of Development
Committee To Protect Journalists
330 Seventh Avenue, 12th Floor
New York, NY 10001, USA
Phone:(212) 465-1004 ext.109
Fax: (212) 465-9568

E-Mail: development@cpj.org