The Alliance – the Gay-Straight Alliance of the New York State Courts c/o Marc Levine; 80 Second Place; Brooklyn, NY 11231 Membership Application: Name: __________________________________________________________ Title: _________________________ What court do you work in?__________________________ Work Number: _________________________ Home or Cell #: ___________________________ Home Address: ___________________________________________________________________ _________________________________________________________________________________ Are you interested in assisting with anything in particular or with the Alliance in general? If so, what would you be interested in doing or in seeing the Alliance do? _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Annual Membership Dues ($10): ______________ Sponsor ($25): _______________ Patron ($50): ______________ Donor ($??): _______________ Make all checks payable to "the Alliance."