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The South Dakota Coalition For Shared Parenting

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

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: _____

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.