Membership Form

Members' donations are 100% tax deductible.

To become a member of CIIN and receive Our Toxic Times, please complete the following and submit with payment:


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Please charge my membership donation of
(Not less than $25 please) to my credit card.

CIIN accepts MasterCard, Visa and Discover cards:

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If this is a gift, please include recipient's name:

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Please include the 3 digit security code from the back of the credit card

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Please mail me a receipt for my donation. (For donations of $50 and over)