Auxiliary to The Ability Center Membership Form

Auxiliary Dues for 2021 – 2022

Membership Dues are - $30.00
*An extra donation of $10.00 or more will help us fund some of the programs that are in need such as:
Assistance Dogs, Community Living, Assistive Technology/Medical Equipment, Scholarship Fund, Life Skills/Next Steps

Please print information as you wish to be listed in the directory.
Your Name*

First Name

Last Name
Spouse's Name*

First Name

Last Name
Address*

Street Address

City

State / Province / Region

ZIP / Postal Code

Country
Home Phone
Cell Phone
Work Phone
Email*
- Active Member – I would enjoy assisting with Auxiliary projects.
- Supporting Member – I am unable to volunteer at this time
I am interested in participating in the following committees:*
- Fashion Show
- Member Communications
- Serve on Auxiliary Board
- Public Relations/Publicity
- Special Events
- Mailings
A representative from The Ability Center to reach out to you to secure membership and payment. For you for your interest in the Auxiliary to The Ability Center.
Phone

This field is for validation purposes and should be left unchanged.

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