Yes! Our congregation wishes to join the Washington Region Religious Campaign Against Torture.

Name of Congregation_____________________________________________________

Address of Congregation___________________________________________________

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Congregation Web Site Address______________________________________________

Congregation Phone Number________________________________________________

Name of Minister, Priest, Rabbi, or Imam______________________________________

Contact Person for WRRCAT_______________________________________________

Email of Contact Person____________________________________________________

Phone Number of Contact Person_____________________________________________

Address of Contact Person__________________________________________________

________________________________________________________________________

Please List our Congregation in WRRCAT Materials as Follows:

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Signature                                                                                                 Date

Printed Name____________________________________________________________

Position in Congregation____________________________________________________

Please return this form to:  WRRCAT, 4716 Ellicott St., NW, Washington, D.C.,  20016.