Membership Form

Please print, fill out, and mail this form, along with a check or money order to:

Artists Network of Refuse & Resist!
305 Madison Ave. #1166
New York City, NY 10165

I would like to contribute:

With a membership of $50 or higher, you will also receive a t-shirt.
For $100, you’ll receive a t-shirt and hand silk-screened poster.

__$35

__$50

__$100

__$250*

__$500*

__$1,000*

__$2,000*

If contributing over $50, indicate which FREE t-shirt you would prefer:

"Danger, Police in Area"
__Small __Medium __Large __X-Large __XX Large

"Refuse & Resist!"
__Small __Medium __Large __X-Large

If contributing over $100, also indicate which FREE poster you would prefer:

__ MUMIA 911 National Poster
__ They Kill Writers/Save Mumia (red)
__ Liberté pour Mumia Abu-Jamal (black)
__ Mumia/Me (white)
__ Win or Die (yellow-green)

* Become a Sustainer of The Artists Network
Funds from our Sustainer Program support the work of our national office and national coordinator, which includes connecting artists with one another, producing events, developing our Inside the Culture of Resistance conversation series, and editing our website.

Customer Shipping Information

With your membership, you will also receive COUNTERATTACK, mailings from the Artists Network, and be added to the Artists Network national listserve.

YES! Please send me Counterattack, your mailings, and add me to your listserve.
No thank you.

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Zip/Postal Code:	_______________	Country:	_________________________
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