Join the Socialist Party of the United States of America
I, the undersigned, desiring to bring about, by democratic means, a new society based upon democratic socialism, hereby apply for membership in the Socialist Party USA, and subscribe to its principles.
Signature: ______________________________ Today’s Date:_______________
City _____________________ State ________________ Zip ______________
E-mail __________________________Phone ______________________
Date of Birth:_______________ Male/Female:_________________
Other Organizations to Which I Belong (Political Groups, Unions, etc.) __________________________________________________________________
Please Send Me More Information About…
 Young People’s Socialist League  International Commission
 Women’s Commission  Queer Commission  Disability Commission
 Labor Commission  Faith and Socialism Commission
 Other (please specify) __________________________________
Annual Dues (based on net annual income):
[ ] Full-time Student: $15 (new members only) Name of school:_________________
[ ] Under $20,000 base rate: $30 (sliding scale up to) $75
[ ] $20,000-35,000 base rate: $75 (sliding scale up to) $150
[ ] $35,000-50,000 base rate: $150 (sliding scale up to) $270
[ ] $50,000-65,000: $270 (plus 1% of net income between $50 -$65,000)
[ ] Over $65,000: $420 (plus 2% of net income over $65,000)
A full or partial waiver is available for financial hardship or long-term unemployment. Waiver requests must be submitted in writing.
Bring to a meeting or mail to: Socialists, c/o 255 Sherbourne Rd., Syracuse, NY 13224.