Return completed form and membership dues to
Arizona Spina Bifida Association
1001 E. Fairmount Avenue
Phoenix, AZ 85014
602-274-3323
602-274-7632 (fax)
Name
Address
City
County
State
Home Phone
Work Phone
Email Address
Fax
Parent/Guardian of child with SB
Adult with Spina Bifida
Name of person with SB
Birth date
Number in household
Web Address (if available)
GENERAL MEMBERSHIP FEES
*Family + National $30
*Family/Individual $10
*Professional + National $40
*Professional $20
The ultimate strength of the Arizona Spina Bifida Association is in its members. Would you please help expand our services by volunteering. (Check the areas you may be able to help)
Newsletter
Write article or send newsworthy items
Help prepare mailings (4 x/year)
Act as Editor
Office
Help prepare mailings
Filing, copying, general office
Make phone calls
Fundraising Events
Serve on committee
Do graphic layout
Make presentations
Committees/Board
Help recruit Board members
Serve a Board term
Serve on Program Committee
Serve on Life Enhancement Comm.
Serve on Communications Comm.
Finance Committee
Serve on Holiday Party Comm.
Serve on Community Council
Please bill my:
VISA MasterCard
In the amount of:
$
Card Number:
Expiration Date (MM/YYYY):
Name on card (if different) :
Personal Check Enclosed