YesSIR of Tennessee

YesSIR (Yes Smoking In Restaurants) of Tennessee

MEMBERSHIP - DONATION BY MAIL PRINTOUT FORM

Print and complete this form, enclose check, or money order for the amount of:

a) $15.00 for Regular Annual Membership
b)$10.00 for students, pensioners or low income
c) $50.00 if you want to become a sponsor
d) $100.00 if you want to sponsor YesSIR through a company

YesSIR
571 Ravenwood Dr.
Maryville, TN 37801
Phone: (865) 681-2282

Yes, I want to become a member of YesSIR-TN organization to help you to defend the rights of ALL consumers against scientific misrepresentations and political repressions. I understand that the YesSIR-TN organization works to preserve the consumer's 'Freedom of Choice' and 'Freedom of Association'. I agree, the Freedom to Choose is my right. ANY prohibition (private or public), based on false science, is an assault on our civil rights and part of a political agenda aimed at the suppression of free choice. Through my membership, I support the cause of liberty, and I may be interested in getting involved in the campaign for the elimination/prevention of smoking restrictions.

Please print and fill the following form. Information sent to us will be kept confidential,
and it will not be disclosed or published by any means without your expressed permission.

Name________________________________________________________________

Address_____________________________________________________________

City_________________________________________________________________

State________________________________________________________________

e-mail address _____________________________ Phone (____)_______________

Smoker________Nonsmoker_______

Do you wish to actively participate in YesSIR-TN? Yes__________ No__________
If so, how? Writing, phoning, website work, donations, other ?

I certify with my signature that I am over 18 years of age.

Signature___________________________________ Date____________________