Print Membership Form
Arizona Association of the Deaf, Inc
Senior Citizen 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:
Senior Citizen Membership Due:
$
Month/Year/Rate
SEPT 2011 $10.00
OCT 2011 $9.60
NOV 2011 $9.20
DEC 2011 $8.80
JAN 2012 $8.40
FEB 2012 $8.00
MAR 2012 $7.60
APR 2012 $7.20
MAY 2012 $6.80
JUN 2012 $6.40
JUL 2012 $6.00
AUG 2012 $5.60
SEPT 2012 $5.20
OCT 2012 $4.80
NOV 2012 $4.40
DEC 2012 $4.00
JAN 2013 $3.60
FEB 2013 $3.20
MAR 2013 $3.00
APR 2013 $2.60
MAY 2013 $2.20
JUN 2013 $1.80
JUL 2013 $1.40
AUG 2013 $1.00
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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