Your Name: Street Address: City: State: Zipcode: E-mail address (something like mom13@mindspring.com or johnsmith@bellsouth.net): Verify E-mail address: If you are about to pay your membership via PayPal, but the e-mail address above is different than the one you use for PayPal, then please re-enter the e-mail address you use for PayPal (something like mom13@mindspring.com or johnsmith@bellsouth.net): Verify PayPal E-mail address: County: Phone (10-digit): FAX (optional - for directory): Years of Kids' Birth (optional - for directory): Comment (optional - for directory): GA House District (optional): GA Senate District (optional): US House District (optional): (To find your district numbers check your voter registration card or look them up on the web at http://www.vote-smart.org, www.congress.org or call Senate Public Information Office at 404-656-5082)
