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Arc Membership
Print this page,
complete it, and mail it along with a check for $15.00 to the address on the
form.
| Name
|
| Organization |
| Address
|
| PO Box |
Apt # |
| City |
State |
Zip Code |
| Phone (
) - |
Work (
) - |
| Email Address |
| Comments:
q
I Would like to receive mailings from the state and national level.
q
I would not like to receive mailings from the state and
national level.
|
|
q
New Membership
q
Renewal Membership
q
Gift Membership for:
|
|
$15.00 enclosed for state and national membership
Mail to: The Arc
of Washington State - Membership
2638 State Ave. NE
Olympia, WA 98506
|
Arc National Survey (optional.)
| Age Group of Member |
q1-24
q25-34
q35-44 q45-54 q55-65
q66+ |
| Classification of Member |
q
Self-Advocate
q
Interested Citizen
q
Professional in the Field of Mental
Retardation
q
Parent/Relative of a Person with Mental
Retardation |
| If parent, age of person with mental
retardation. |
q
1-21 q
22-35 q
36-50
q
51+ |
|
q
I would like to receive mail from National Arc. |
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