Join the Initiative

Directions: Please complete the form below. A copy will be emailed to you to print and send with a check for your selected class type. Checks should be made payable to PEPA at Box 21, Purchase, NY 10577. Your information is kept confidential and will not be shared with any to third parties.

For more information about our membership program, click here.

1. Confirm Opt In

Yes! I would like to help support PEPA in its important work. Please add my e-mail address to PEPA's listserv (your e-mail address is kept confidential and will not be distributed or sold).

2. Personal Info

First Name

Last Name

Mailing Address

City

State

Zip Code

Phone (Optional)

Fax (Optional)

3. Class Type

Select Class A

Voting Member ($100) — send a check with a printed copy of this application.

Select Class B

Concerned Citizen ($0) — no further action is required.

Join the Initiative

1. Confirm Opt In

2. Personal Info

3. Class Type

4. Issues of Concern