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Arizona Association of the Deaf, Inc Regular Membership Form

Fill in boxes by typing then print the form and mail. New Renewal Change of Address Full Name: Address: Apt/Unit/Site: City/State/Zip: TTY Voice Both: VP: Fax: E-mail: Your Signature:     Date: ASDB Alumni? Yes  PDSD Alumni? Yes Check the box and fill out the amount below:  Regular Membership Due: $ Month/Year/Rate SEPT 2011 $24.00 OCT 2011 $23.00 NOV 2011 $22.00 DEC 2011 $21.00 JAN 2012 $20.00 FEB 2012 $19.00 MAR 2012 $18.00 APR 2012 $17.00 MAY 2012 $16.00 JUN 2012 $15.00 JUL 2012 $14.00 AUG 2012 $13.00 SEPT 2012 $12.00 OCT 2012 $11.00 NOV 2012 $10.00 DEC 2012 $9.00 JAN 2013 $8.00 FEB 2013 $7.00 MAR 2013 $6.00 APR 2013 $5.00 MAY 2013 $4.00 JUN 2013 $3.00 JUL 2013 $2.00 AUG 2013 $1.00 Contribution (The AzAD is a 501(c)(3) organization; allcontributions are tax-deductible to the extent allowed by the law.) $ Thank you for supporting AzAD!     Total Amount: $ Please pay above total amount to authorized person or mail check or money order payable to: Arizona Association of the Deaf, Inc 5025 N. Central Ave.  PMB #277 Phoenix, Arizona 85012

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