(print below and send)
The South Dakota Coalition For Shared Parenting
Membership Form
Annual Membership Dues**: $20
Please send a check or money order with the requested information below payable to:
SD Coalition for Shared Parenting
Steve Mathis, Treasurer
916 Locust Street
Yankton, SD 57078
Please begin a membership for me in The South Dakota Coalition for Shared Parenting. Please find enclosed my tax-deductible** dues of $20.00***.
Name __________________________________________
Address __________________________________________
City _______________ State _______ Zip _________
Home phone number (______) _______________
Work phone number (______) _______________
Fax number (_______) ________________
Email address_______________________________
Marital Status: Married*: _____ Separated*: _____
Divorced*: _____ Grandparent: _____
Step-parent: _____ Single: _____
*How long?
Occupation: ___________________________________________
Children (gender and ages): Boys: ________________ Girls:________________
How did you hear about the SDCSP? __________________________________________
I have enclosed a contribution** of $_________ to assist the South Dakota Coalition in carrying out its goals.
** The South Dakota Coalition for Shared Parenting is a 501(c)(3) organization by the IRS. Your dues and any contributions you make are considered tax deductible. All contributions and dues paid since January 18, 2000 are considered tax deductible by the IRS.
***Voting membership is open to all residents of South Dakota and the surrounding area that has primary business in South Dakota, however, any person or organization can make a tax deductible contribution.
