YES! I want to join or renew my ADC membership and be part
of ADC’s success.
Name:___________________________________________________
Address: ________________________________________________
City: _________________ ST: _____________________ Zip
_____________
Tel (Day) _______________________ Tel.
(Eve)_________________________
EMail___________________________________________________________________
ALL DUES MUST BE PAID IN US DOLLARS
U.S. and Canada
Individual……………… 1 yr
$10
Family…………………..1 yr
$25
Student/Limited income....1 yr
$5
Count
on me to Support ADC! I would
like to give over and above my membership.
$10,000 For the Benefactors circle
$5,000 for the Chairs Council
$1,000 for the Presidents Club
YES,
I want to do more. I would like
to make a monthly pledge to ADC.
Please
charge $ __________ to my credit card account [sign credit card
authorization below] starting on ________/__________ (month/year).
- I understand that I must send written notice to ADC to change the
amount or to terminate the pledge.
Dues
$
__________
Contribution
$
__________
Monthly
Pledge $ __________
Total
$
__________
PAYMENT
INFORMATION
DO
NOT SEND CASH
ꪙ
Check (make payable to ADC)
ť VISA
ť Master Card ť Am/Ex
_____________________________________
__________/___________
Credit
Card Number
Expiration Date
_____________________________________
Signature (Name as it appears on card)
