Thomas Paine Society

Membership/Contribution Form

Please print out this form, fill it in, and mail it to our office listed below.
Please make check or money order payable to "Thomas Paine Society."

I wish to support the work of the Thomas Paine Society.


I wish to join at this time . Regular Annual Membership:$25 ____

I wish to join at this time at an additional level . Annual Membership:$ ____

I am only making a contribution at this time. ____

I am enclosing my tax-deductible gift, made payable to Thomas Paine Society, in the amount of:

US $ ____


Name___________________________________________ 

Address_________________________________________ 

City/State/Zip/Country______________________________ 

Phone___________________________________________ 

E-mail___________________________________________ 

Personal information, including e-mail address, will not be sold or shared.


Membership/Contributions in support of the Thomas Paine Society may be sent to the following address:

Thomas Paine Society
99 S. Raymond Ave.
Suite B001
Pasadena, CA 91105

Phone: (626) 796-4529
Fax: (626) 683-0962

Thank You