Membership Form


Housing Opportunities Made Equal Membership Form
Please print out, fill in and mail
Please Circle One:
	Dr.	Mr.	Ms.	Mrs.	Other:_________________

Please Print:
	Full Name:____________________________________________________

	Address:_____________________________________________________

	City:_____________________ State:___________ Zip Code:________

	Telephone: ( )_______________________________________
	E-Mail Address:________________________________________________

Select One:
______	$10 Student/limited income membership
______	$30 Individual membership
______	$40 Family membership
______	$50 Contributing membership
______	$100 Patron membership
______	$200 Sponsor membership
______	$500 Benefactor
______	$_____Other

How did you hear about HOME?
______	Surfing the web
______	Researching fair housing
______	Already familiar with the organization
______	Presentation/Workshop
______	TV/ Radio, which station?_____________
______	From a board/staff member, who?______________________________
______	Promotional material/brochure, located where?____________________
______	Other, please explain_________________________________________

	Please send with a check/money order to made payable to:
	HOME, Inc.
	700 Main Street
	Buffalo, NY 14202

	THANK YOU FOR YOUR GENEROUS SUPPORT OF FAIR HOUSING!

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