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.
Comments

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