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Illinois Association of the Deaf

Individual Membership Form

One entry per person.

Mail Payment to:
PO Box 1275
Oak Park, IL 60304

 

Contact Information

First Name *
Please let us know the name of your organization
Last Name *
Please let us know the website of your organization
Spouse / Partner
Please let us know your contact person's name
Your Email
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Spouse/Partner Email
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Address *
Please let us know your organization's address
City *
Please let us know your city
State *
Please let us know your state
Zip *
Please let us know your zip
Phone *
Please let us know your phone number
Phone Type
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Membership Status




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* If your membership has expired for three months or more


Personal

Please select all that apply: *





Please let us know the type of affiliate registration


Chapter of IAD

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NAD Membership:

Are you a member of NAD?
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Illinois Registered Voter:

Are you a Registered Voter?
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Gift Membership

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Please complete this form using information of the person receiving the gift membership.
Your Name and Address
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State-Wide Bulletin Newsletter

I would like to receive newsletter by:
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Referred by:

Name of Person
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IAD Membership:










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IAD Donations

Affiliate Organization would like to make a donation amount to support the following
(please enter your donation amount):
General Fund
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Miss Deaf Illinois Fund
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YLC Scholarship
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Conference Fund
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Senior Citizen Fund
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Legislative Fund
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KODA Fund
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Diversity Fund
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J.B. & Bea Davis Scholarship
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Francis L. Huffman Fund
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Youth Fund
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Total Donation Amount:
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Payment Information

Total Amount Payable to IAD:
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Please type the letters here to let us know you are human Please type the letters here to let us know you are human
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Mail Payment to:
PO Box 1275
Oak Park, IL 60304