MEMBERSHIP FORM
Please print this form and mail it in with your check to:

PEDS
57 Forsyth Street, Suite 222-G
Atlanta, GA 30303
404-522-3666

Yes! I want to make Atlanta pedestrian-friendly!

Individual/Household
$25-$49, Foot Soldier
$50-$99, Whistle Blower
$100-$249, Urban Trailblazer
$250-$499, Sponsor

Neighborhood or non-profit organization
$50

All contributions are tax deductible!

Name 1,    First: _____________ Last:_________________________________

Name 2,    First: _____________ Last:_________________________________

Organization: _____________________________________________________

Address: ________________________________________________________

City, ST, Zip: ____________________________________________________

Home Phone: ____________________ Work Phone: ____________________

E-mail: _________________________________________________________
(PEDS uses e-mail 3 to 5 times per month to inform members about important events,
legislative issues and articles of interest. PEDS will not sell or share your e-mail address.)

How did you hear about PEDS? _____________________________________