Mail to: The Electronic Frontier Foundation, Inc.
         155 Second St. 
         Cambridge, MA 02141


I wish to become a member of the EFF  I enclose:$__________
            $20.00 (student or low income membership)
            $40.00 (regular membership)
            $100.00(Corporate or company membership.
                    This allows any organization to
                    become a member of EFF. It allows
                    such an organization, if it wishes
                    to designate up to five individuals
                    within the organization as members.)


    |     I enclose an additional donation of $___________


Name:______________________________________________________


Organization:______________________________________________


Address: __________________________________________________


City or Town: _____________________________________________


State:_______ Zip:________ Phone:(    )_____________(optional)


FAX:(    )____________________(optional)


Email address: ______________________________


I enclose a check [  ]   .
Please charge my membership in the amount of $_____________
to my Mastercard [  ]     Visa [  ]      American Express [ ]


Number:____________________________________________________


Expiration date: ____________


Signature: ________________________________________________


Date:______________________


I hereby grant permission to the EFF to share my name with
other non-profit groups from time to time as it deems
appropriate   [  ]  .
                       Initials:___________________________


Your membership/donation is fully tax deductible.
