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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 NOV 2009 $24.00 DEC 2009 $23.00 JAN 2010 $22.00 FEB 2010 $21.00 MAR 2010 $20.00 APR 2010 $19.00 MAY 2010 $18.00 JUN 2010 $17.00 JUL 2010 $16.00 AUG 2010 $15.00 SEP 2010 $14.00 OCT 2010 $13.00 NOV 2010 $12.00 DEC 2010 $11.00 JAN 2011 $10.00 FEB 2011 $9.00 MAR 2011 $8.00 APR 2011 $7.00 MAY 2011 $6.00 JUN 2011 $5.00 JUL 2011 $4.00 AUG 2011 $3.00 SEP 2011 $2.00 OCT 2011 $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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