
subscription: $10 a year + one for a friend
Please make checks payable to the "Democratic Socialists of America Fund"
(DSA Fund) and write "the activist" in the description.
Send this form and your check to:
the activist
180 Varick Street
12th floor C/o DSA
New York, NY 10014
| Your Name | |
| Your Email | |
| Your school (if any) | |
| Expected Date of graduation | |
| Your Temp/School Address | |
| Street 1 | |
| Street 2 | |
| City | |
| State | |
| Zip | |
| Phone | |
| Address valid until | |
| Your Permanent Address | |
| Street 1 | |
| Street 2 | |
| City | |
| State | |
| Zip | |
| Phone | |
| Friend's Name | |
| Friend's Email | |
| Friend's school (if any) | |
| Expected Date of graduation | |
| Friend's Temp/School Address | |
| Street 1 | |
| Street 2 | |
| City | |
| State | |
| Zip | |
| Phone | |
| Address valid until | |
| Friend's Permanent Address | |
| Street 1 | |
| Street 2 | |
| City | |
| State | |
| Zip | |
| Phone | |