Print Membership Form
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
Name (First Person):
Name (Second Person):
Address 1:
Address 2:
City/State/Zip:
TTY
Voice
Both:
VP:
Fax:
E-mail:
Your Signature:
Date:
Check the box and fill out the amount below:
Regular Membership Due:
$
Month/Year/Rate
JAN 2008 $22.00
FEB 2008 $21.00
MAR 2008 $20.00
APR 2008 $19.00
MAY 2008 $18.00
JUN 2008 $17.00
JUL 2008 $16.00
AUG 2008 $15.00
SEP 2008 $14.00
OCT 2008 $13.00
NOV 2008 $12.00
DEC 2008 $11.00
JAN 2009 $10.00
FEB 2009 $9.00
MAR 2009 $8.00
APR 2009 $7.00
MAY 2009 $6.00
JUN 2009 $5.00
JUL 2009 $4.00
AUG 2009 $3.00
SEP 2009 $2.00
OCT 2009 $1.00
NOV 2009 $24.00
DEC 2009 $23.00
Contribution
(The AzAD is a 501(c)(3) organization; all
contributions 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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