-
Name:__________________________________________________________________
-
Spouse
name:____________________________________________________________
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Address:_________________________________________________________________
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City:______________________________________ State:_________
Zip:_____________
-
Telephone:_________________________________________
q
TTY
q
Voice
q
Both
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Email
Address:____________________________________________________________
- q
Check here for Address/Information Correction
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I have read, understood and
accept to follow WSAD Constitution and By-laws (posted on our
website: www.wsadeaf.org).
THE MEMBERSHIP WILL NOT BE
VALID WITHOUT YOUR SIGNATURE(S).
-
Signature:
X____________________________________________________
-
Spouse Signature:
X________________________________________
- q
New q
$10 – Individual*
- q
Renewal q
$15 – Married Couple/Family (children under 18y/o)
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*Multi-year membership accepted
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- Make
checks payable to: West Suburban Association for the Deaf
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Select all that apply:
- q
Deaf q
Hard-of-Hearing
q
Hearing
- q
CODA q
Interpreter
q
Single
- q
Male q
Female
q
Married
- Would you be interested
in becoming a volunteer for WSAD Committee/events? Yes No
- Would you be interested
in becoming a WSAD Board member? Yes
No
- Would you like WSAD
newsletter/flyers sent via E-mail?
Yes No
-
-
Ideas – Suggestions – Improvements?
Please fill
in – Thanks!
-
- Mail
to: WSAD - Secretary
-
P.O.
Box 3712
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Oak Brook, IL 60522
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