| DAWN, Center for Independent Living, Inc. |
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Membership Application
As a member of DAWN, Inc., you will be entitled to
reduced rates to special events, newsletters, and the
right to vote at DAWN, Inc. business meetings. We are
here to help you, the consumer. Please
help us help you by joining DAWN, Inc.
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| Basic ___________ $15.00 |
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Family __________ $25.00
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Organization / Professional __________ $100.00
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Other Donation $____________________
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Name
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__________________________________________________________
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Address
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__________________________________________________________
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__________________________________________________________
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City/State
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__________________________________________________________
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County
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________________________________________
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Zip
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________
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Telephone
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__________________________________________________________
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| I will be attending activities: |
__________ |
| Please check one: |
| I wish to receive the newsletter only |
__________ |
| I wish to receive the activity schedule only |
__________ |
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DAWN, Inc. would like to use your photograph and/or
name in our promotional material (newsletters,
posters, etc.) If you agree, please initial one or
both of the following permission statements.
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_____________ |
I give DAWN, Inc. permission to publish
my photograph.
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_____________ |
I give DAWN, Inc. permission to publish
my name.
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Please return to:
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DAWN, INC.
30 Broad Street
Suite #5
Denville, New Jersey 07834
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Information filed with the Attorney General concerning this charitable solicitation may be obtained from the Attorney General of the State of New Jersey by calling: (973) 504-6215. Registration with the Attorney General does not imply endorsement.
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All contributions are tax deductible.
22-3496995
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