Membership Form

Please tell us who you are:

Name:		This information is required, thank you.
E-mail:		This information is required, thank you.
Tel:		This information is required, thank you.
FAX:		This information is required, thank you.

Mailing info: (needed to send you a pledge form to fill out and send back to us)
 

Do you wish to be contacted for membership renewal: 

  Yes      No 

Phone:     Mail:

Do you want to be on an email alert list for legislation and events:   Yes    No 

Contribution amount:

Notice:  To be a voting member the minimum annual membership contribution is $5.00

Please Choose how you would like your contribution applied:

COACT Education Foundation (donations to CEF, a 501c(3) are tax deductible)

Minnesota COACT  (a 501(c)4 non-profit. Donations are not deductible)

make checks payable according to your choice.

 For your security-All Credit card payments -please call in or

 download our form and mail it in.

Primary Areas Of Concern:

Health Care: Prescription Drug prices, Food Safety, Access to Affordable Insurance,

Other

Agriculture:  Dairy Prices, Crop Prices, Where to Buy Locally Grown Food, Feedlots, Agricultural Stewardship,

Other

Your contribution will be put right to work for you.

Enter any comments in the space provided below:

Please contact me as soon as possible regarding this matter.