| DIAL, Inc. Membership
Application Form..... |
|
| I would like to be a member of DIAL and contribute
to independent living |
| for all people. |
| |
| Membership Options: |
| |
| New_______ Renewing_______ |
| (All memberships expire 12/31 of each year) |
| |
| _______Individual $15.00 |
| _______Family $25.00 |
| _______Organization/Professional $75.00 |
|
| |
| _______I want to receive newsletters ONLY |
| _______I want to receive activity notices |
| _______I wish to participate in DIAL events |
|
| |
| Name__________________________________________________ |
| Address__________________________________________________ |
| City__________________________________________________ |
| State and ZIP__________________________________________________ |
| Telephone #__________________________________________________ |
|
| |
| Send your membership check or money order
to: |
| DIAL, Inc. |
| Center for Independent Living |
| 2 Propect Village Plaza |
| Floor 1 |
| Clifton, NJ 07013-1918 |
|
| |
| If you wish to download the membership application
form, please visit the |
| downloads page
located on the menu bar for the DIAL, Inc website. |
| |
|
