WSAD Membership Form

WASHINGTON STATE ASSOCIATION OF THE DEAF

WSAD Membership Form

JOIN WSAD! Add YOUR voice with us!

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

Yes, I would like to join WSAD!

Name: _________________________________________________________

Address:_______________________________________________________

City:______________________________________

State: ______________________ Zip Code:___________________________

Phone (will be kept confidential)

Voice / TTY / Both: _______________________________________________

VP or Fax: ______________________________________________________

Email: _________________________________________________________

Donations: (In Addition to Membership Fee)

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
13503 80th Ave S.
Seattle, WA 98178

For IRS Tax deduction, WSAD is incorporated as a 501c(3) non-profit organization.

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