1. Name(s)

2. Phone Work Home

Best time to call:

3. Do you support our position on the estate tax?

Yes
No
Not sure, need more information

4.Please indicate if you would like us to send more information about:

RESPONSIBLE WEALTH:
General Information
Tax Fairness
Shareholder Resolutions
Living Wage
The Estate Tax

UNITED FOR A FAIR ECONOMY:
General Information

5. Would you like to be on our mailing list?

Yes
No

If yes, please give us your mailing address:

Organization:
Street Address:
Street Address:
City:
State: Zip:

6. Would you like to be on our email list?

Yes
No
If yes, please give us your email address:

7. Do you have any questions about Responsible Wealth? Would you like one of our program staff to call or email you?

Yes, please call
Yes, please email
No, do not call or email

8. Are you interested in joining Responsible Wealth?

Criteria: Household is in top 5% of wealth or income:
Household income over $135,000 or net assets over $650,000.

Dues: $150 per year Individual / $250 per year Couple

You can join RW over the web with a Visa or MasterCard using our secure server.

Or, you may print out a hard copy form and mail or fax it to us with a check or credit card number.

Or, simply send a check payable to "Responsible Wealth" and mail to:

Responsible Wealth
29 Winter Street, 2nd Floor
Boston, MA 02108

9. Any other comments for us? If you have a question or comment and would like us to respond, please include your email address. Thanks!