RCAD Membership Form
Bring the completed membership form along with
your member dues to the next RCAD Meeting!Membership Application 2008
Today s Date: ________________________________________________
Name: _______________________________________________________
Address: _____________________________________________________
City: ________________________________________________________
State: _________________ Zip: ________________________________
Phone Number: ___________________________________Voice or TTY
Email: ______________________________________________________
Are you (circle one): Deaf, Hard of Hearing, Hearing
Are you a member of FAD: Yes No
How would you like to receive the RCAD Newsletter?
_______ through email
_______ through regular mail (letter)
*************************************************************
For Treasurer/Assistant Treasurer’s Use Only:
Cash Received: ____________________________________________
Check Received: ___________________________________________
Check # and Date: _________________________________________
Cash or Check Received by: _________________________________
Card Given or Mailed/Date/Number: _______________________
You can then print off the form and bring it to the next meeting or email the attachment to
or
then bring your dues to the next RCAD Gathering!
