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Home Site Map		Private Citizen, Inc. PO Box 233 Naperville, IL 60566 630-393-1555 e-mail To join on-line: click here
Print this form to Cut Junk Calls / Cut Junk Mail. Fill it in and send it to us with your membership fee. We will then have your legal authorization to Cut Junk Calls / Mail for you.

Junk Calls - Send me Private Citizen's membership materials to cut junk calls; and Notify over 1,000 local and national telemarketing firms, that: "I hereby adopt the Notice and Offer (linked here) as my own and appoint Private Citizen, Inc. as my agent to send it to entities involved in telephone solicitation, advising them of my Notice and Offer, as well as my name, city, state, zip code and phone number/s."

In brief, it states that you:
- are unwilling to freely receive junk phone calls, and consider them an invasion of privacy,
- offer junk callers the use of your phone and/or time, on a for-hire basis of $500 per call,
- define a junk call as one intended to solicit sales, donations, survey data or political support.

Junk Mail - S end me Private Citizen's membership materials to cut junk mail and include The Ultimate Junk Mail Weapon. Also, copy my Notice that: "I do not want unsolicited junk mail. Remove my name from all mail, direct marketing lists or directories you compile, control or influence. You may tell other firms of my request. A copy of this Notice is as valid as an original." Then, as my agent, send this Notice to:
	Donnelley Marketing Direct Marketing Assn.	Trans Union, Inc. R.L. Polk & Co.	Abacus Direct ADVO Systems	Haines & Comp. Acxiom, Inc.
c.c.: U. S. House of Representatives - Committee on Government Reform & Oversight

Your Information
________________________________________ Print Name (ex. spouses, John / Jane Doe) ________________________________________ Street Address or P.O. Box ________________________________________ Location (City, State & Zip)	________________________________________ List an extra person / firm for an added $5 ________________________________________ List an extra address - add $5 ________________________________________ List an extra Location
________________________________________________________ __________________ SIGN Here (a representative of the residence or business must sign) Date
(_____) ______-__________ (_____ )______- __________ (_____) ______-__________ Enter phone / fax / cell number List additional numbers for an added $5 each

To protect unlisted phones, the Private Citizen Directory lists numbers and names in separate tables.

Membership Options
Initial Here:_____	To:	Cut Junk Calls	Basic membership		$	2	0	______
Initial Here:_____	To:	Cut Junk Mail	Basic membership		$	1	0	______
. .		Add $5 for each extra; Name, Address, Phone ___		x	$		5`=`	______
. .		Book	(non-members = $10 / members = $5)		$			______
. .		Total	make payable to Private Citizen, Inc.		$			______
. .		Check encl. [ ] Visa [ ] MasterCard [ ] Discover [ ]
		Card # ___________________________________ Exp. Mo__ Yr__

Snail-mail to:

Private Citizen PO Box 233 Naperville, IL 60566