Application for Individual Membership
in the Libertocracy Association and the Human Liberation Alliance
There is no cost or obligation
* Required field / + Preferred field / Other fields optional

1. Name*
2. Street+
3. City   +State/ProvinceCountry+
4. Zip Code +

5. Sex  *
6. Age  

10. E-mail      * Please be sure and include your e-mail address
11. Telephone
12. FAX       
13. website   

14. Do you wish to join and concentrate your activities in any of the following sub-organizations?
Please select your special interest, if any.

Alliance for Individual Sovereignty
Alliance for the Family
Womin's Rights Alliance
Men's Rights Alliance
Children's Rights Alliance
Sexual Freedom Alliance
Pursuit of Cultural Excellence Foundation
Liberal Education Achievement Foundation
Alliance for National and Ethnic Liberation
Libercratic Community Associations
Security Services Alliance
Free Enterprise Alliance
Environmental Protection Alliance
Libercratic Party

Do you want to be added to the Libertocracy discussion group at (groups.yahoo.com/group/libertocracy)?

Thank you for your interest in becoming a member, we look forward to a mutually beneficial relationship.

    

Joining the Libertocracy Association and Human Liberation Alliance is a commitment to work for the organization.
Members agree to volunteer in some capacity, as suits one's abilities, time and preferences, to serve the organization and follow the leadership principles of the Alliance. There is no obligation.
You may do as much or as little as you want, whenever you want, as fits your schedule.

There is no charge for becoming a member of the Libertocracy Association or the Human Liberation Alliance.

Membership includes the monthly Libertocracy Association Newsletter with periodic updates, you can unsubscribe to the newsletter later if you want.

All information you give on this form, and in future communications, is kept completely confidential. It will be kept on record by the Libertocracy Association who will never under any circumstances allow this information to be given or sold to other parties, nor will it be voluntarily divulged to any state or its agents. The Libertocracy Association will take all reasonable security measures to insure that any information you give to us will be protected.