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Become a Member:

For payment and donation, you have two options. You may either fill out the online form below and pay your membership dues using Paypal (which accepts all major credit cards), or you may fill out the attached application and mail a check to the Long Beach Immigrant Rights Coalition, in care of UUCLB, at 5450 E. Atherton St., Long Beach, CA 90815). LBIRC thanks you for your support!

Note: the form below is for our general information and contact, and will redirect you to the Paypal page to pay. All donations are tax deductible and our 501(c)(3) number is available on request.

Name (First and Last)

E-mail Address

Phone Number
Please list your best phone number, mobile, home, or work.

Address
Example: 111 First St. Apt #3

City, State, and Zip Code
Example: Long Beach, CA 90802

Interests (Check any)?
Local Campaigns and ActionsESL and CitizenshipLegal AssistanceOther (please specify)

Talents or skills you have that might benefit LBIRC

Donation Amount
Please enter the amount you intend to donate for membership, or "other". When you click "Submit", you will be re-directed to a payment page for processing. Please donate the amount you select here
$10 per month$15 per month$20 per month$25 per monthOther Amount (please specify)

Any additional comments:

 

LBIRC Membership Form 2017 English

LBIRC Membership Form 2017 Spanish