WASHINGTON STATE ASSOCIATION OF THE DEAF
Annual Membership Dues: (Jan-Dec)
New 1st Time: $ 8.00
Individual: $15.00
Affiliate Organization: $15.00
Senior Citizen (60 & Over): $12.00
Interpreter: $15.00
Child/Student (up to age 18): $10.00
Name: _________________________________________________________
Address:_______________________________________________________
City:______________________________________
State: ______________________ Zip Code:___________________________
Phone (will be kept confidential)
Voice / TTY / Both: _______________________________________________
Fax: ___________________________________________________________
Email: _________________________________________________________
Donations:
General Fund: (Purpose: Funding for operational expenses) $__________________
Endowment: (Purpose: Funding for Retirement Home
$__________________
TOTAL amount enclosed: $__________________
Print this and make check or money order payable to WSAD and mail to:
Lester Morris, WSAD Treasurer
1860 S. 284th Lane # M104
Federal Way, WA 98003
For IRS Tax deduction, WSAD is incorporated under IRS rules 501c(3) and is a State Charity organization.
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� copyright 2004 Washington State Association of the Deaf (WSAD)