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| MAIL-IN OPTION If you would like to join the Society please print and fill out this form and mail it to: AUTISM SOCIETY OF NH PO Box 68 Concord, NH 03302-0068 A one-time waiver of dues can be granted for hardship. For a limited time, NEW members will receive a free autism awareness decal. Tax-deductible donations are highly encouraged so that we can continue our work in "improving the lives of all affected by autism through education, advocacy, and support." Make checks payable to: Autism Society of NH Name: _______________________________________________________________ Address: ____________________________________________________________ City/Town: __________________________________________________________ Telephone: __________________________________________________________ Email Address: ______________________________________________________
Check One: _____ $30.00 Annual Family Membership fee enclosed _____ $15.00 Annual Individual Membership fee enclosed _____ $10.00 Annual Student Membership fee enclosed _____ Request waiver of dues this year (one-time only) _____ I would like to make a tax-deductible donation Reason for interest: ___________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ for mail in application, cut on dotted line and send in top ------------------------------------------------------------------------------ |
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