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MWADB MEMBERSHIP FORM
The Metropolitan Washington Association of the Deaf-Blind (MWADB) is a social organization which meets monthly. Each member is entitled to receive newsletters twice a year, the latest e-news, and discount rates for social gatherings.
rNEW rRENEWAL rCHANGE OF ADDRESS
|
1 YEAR |
2 YEARS |
| r$15 - Individual | r$26 - Individual |
| r$10 - Student | r$18 - Student |
| r$10 - Senior (62 and over) | r$18 - Senior |
| r$25 - Couple | r$46 - Couple |
| rTax-deductible Donation (Thank you) $________ |
Name(s):_____________________________________________
Address:_____________________________________________
City,
State, Zip+4:______________________________________
E-mail
address:_____________________ Fax #:(___)___-_____
Want on e-mail news list for announcements? Yes ___ No ___
Home Phone #: (___)___-____ Work Phone #: (___)___-_____
Your Birthday for newsletter greeting (month/day):__________
Newsletter Preference: rLarge Print rBraille rE-mail
Make a check or money order payable to the order
of
MWADB and mail this form along with the payment to:
Eddie Martinez Jr.
MWADB
Membership Coordinator
Gallaudet University
800 Florida Avenue NE #115
Washington, DC 20002