Check your choice(s) and fill in the information below.
(    ) I want to become a Member and I enclose $20.00 for one year's dues.
(    ) I want to support Cyber Citizens For Justice, Inc. with my enclosed donation.
        NOTE: *Donations are NOT tax deductible*
(    ) Recommended / Sponsored by:______________________
_________________________________________________________
INTERESTS  (CIRCLE CHOICES)

1. Reforms of Condominium Law FS 718

2. Laws related to Deed-Restricted Communities with a Mandatory
    Homeowners' Association and/or Master Association FS 720
3. Homeowners' Association Foreclosures

4. Reform of FS 190 – Community Development District

5. Property Insurance Reform
6. Other ______________________________________

Name:________________________________

Address:______________________________

City:__________________________________

ZIP + 4:_______________________________

County:_______________________________ 

Phone:   (___)__________________________

E-Mail Address:_________________________

SIGNATURE:___________________________

Date:________________
(   ) In order to qualify for membership, I certify that I own a residence in Florida

Send Membership Application with your personal check to:

Cyber Citizens For Justice, Inc.
Jan Bergemann, President
1156 Tall Oaks Rd.
DeLand , FL 32720-1225
Phone:   (386) 740-1503                              Revised 07/25/2012  JB