If you would prefer to fill out a paper form, please click here: Membership

Membership Application

Please provide the following contact information:

Name
Local affiliation
Phone (optional)
E-mail

Level of Participation:

Receive email updates regarding TALI
events/activities
Attend Steering Committee meetings (monthly)
Assist in TALI events/activities

Choose one of the following options:

Annual Dues:

Group/Local: $50.00
Individual:     $25.00




Copyright 2014 [Take Action, Long Island]. All rights reserved.
Revised: 03/24/14