MAIL-IN OPTION
If you would like to join the Society please print and fill out this form and mail it to:
AUTISM SOCIETY OF NH
PO Box 68
Concord, NH 03302-0068
Dues may be waived for hardship.
For a limited time, NEW members will receive a free autism awareness decal.
Tax-deductible donations are highly encouraged so that we can continue our work in "improving the lives of all affected by autism through education, advocacy, and support."
Make checks payable to: Autism Society of NH
Name: _______________________________________________________________
Address: ____________________________________________________________
City/Town: __________________________________________________________
Telephone: __________________________________________________________
Email Address: ______________________________________________________
Check One: New Member _____, Renewal _____, Don't Know _____
Check One:
_____ $30.00 Annual Family Membership fee enclosed
_____ $15.00 Annual Individual Membership fee enclosed
_____ $10.00 Annual Student Membership fee enclosed
_____ Request waiver of dues this year
_____ I would like to make a tax-deductible donation
Reason for interest: ___________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
for mail in application, cut on dotted line and send in top
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or
ON-LINE OPTION
Annual Family Membership $30.00
Annual Individual Membership $15.00
Annual Student Membership $10.00
Or Make a Tax-Deductible Donation
THANK YOU!
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