Response Form

Name:

Organization:

Street Address:

City: State: Zip:

Telephone Number:

Fax Number:

Email:

Please indicate if you are joining as an individual or organization.

✓ Yes , you may list me and /or my organization as a member of the

Compassionate Use Campaign.
Please fax this form to ( 6 0 9 ) 3 9 6 - 9478, or Mail to: C o m pa s s i o n ate Use Campaign
C/O Drug Policy Alliance New Jersey • 16 West Front Street, Suite 101A, Trenton, New Jersey 08608

I/We are willing to participate in the Campaign in the following ways:

Write letters to state legislators or the Governor.
Coordinate your organization's membership to write letters or attend
legislative hearings.
Attend campaign strategy meetings.
Attend legislative hearings.
Testify at legislative hearings on the issue.

Sponsored by Drug Policy Alliance New Jersey • 1 6 W e s t F r o n t S t r e e t , S u i t e 1 0 1 A , Tr e n t o n , N e w J e r s e y 0 8 6 0 8

Phone: 609-396-8613 • Fax: 609-396-9478 • E m a i l : n j @ d r u g p o l i c y. o r g