Update Contact Info
 
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I.A.D.
PO Box 1275
Oak Park, IL 60304-1275
 
 
 

Please make any necessary changes on this form to help IAD Membership Chair, Kim Eischen, update the membership listing/contact information.  This include new phone number, VP number, address, moving to a different Chapter, etc. If you rather print the membership form to fill out and send to Kim - click here for the file.

Thank you!

Shaded Boxes (orange) - required to be filled out

Name:  

Spouse's Name: 

Street:   

City:       State:       Zip Code:   

Telephone:    TTY   Voice  Both

Email:   

VP:    Sorenson   D-Link

Check here if this is a NEW address since you have joined IAD.

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Copyright © 2002 Illinois Association of the Deaf (IAD). All rights reserved.
Revised: 07/15/05.