Return

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

                                                                      Developmental Disabilities    
q Parent/Relative of a Person with a Developmental Disability
If parent, age of person with a Developmental Disability. q 1-21      q 22-35    q 36-50     q 51+
q I would like to receive mail from National Arc.