Member Registration Form

As a registered member, you are able to participate as an active volunteer and receive special emails.

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Please fill out the entire form below and click the continue button. All fields marked with an " * " are required to continue.
 
Prefix     (e.g. Mr., Mrs., Miss etc.)
First Name *
Middle Initial  
Last Name *
Suffix     (e.g. II, III, IV, Jr., Sr. etc.)
Organization  
Title/Position  
E-Mail *
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Street Address Line 1 *
(e.g. 123 Main St. Apt 101)  
Street Address Line 2  
- optional -  
City *   (Military Personnel - Enter FPO or APO)
U.S. State     (Military Personnel - Select AE, AP or AA)
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U.S. Phone   ( ) -
 
  If you reside outside the United States, please complete the following section.
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Outside U.S. State/Region  
International Phone  
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A check in this box will allow you to recall all your contact details in the future by providing only your last name and e-mail address as entered above. For security reasons, your information can only be recalled if you are sitting at this computer. Also, no credit card information can be recalled.

About You
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Where did you hear about us?

By responding to this offer or program, you agree to receive periodic updates and opportunities to get involved with our organization and ACT for America, the American Congress for Truth's sister organization. ACT for America is an issues advocacy organization. You will have the opportunity to opt-out in the footer of all email communication.


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American Congress for Truth
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