CDR Membership Application

USE THE FOLLOWING TO CALCULATE YOUR DUES, YOU DON'T NEED TO SEND IN THIS PART!

Regular membership is due yearly, the rates are below.
Lifetime memberships are available for $200 per person.

Regular Annual Dues: $25.00
Student/Low Income Annual Dues: $10.00
Family (2 people) Annual Dues: $40.00
Each extra person Annual Dues: $4.00

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PLEASE CUT HERE AND SEND THIS PART IN:  (Please print clearly)

Lifetime Membership $200.00___   $______
Contribution:   $______
Total Amount Due:   $______
FIRST NAME, MIDDLE INITIAL, LAST NAME [   ]  New or [   ]  Renewal
STREET ADDRESS, APT. #
CITY STATE ZIP CODE (9 digits)
TELEPHONE FAX E-MAIL ADDRESS (print carefully)
DATE AMOUNT ENCLOSED  

[    ] Please put me on the CDR Members Exchange via Yahoo Groups (must supply e-mail address)

Instructions:
PRINT OUT THIS FORM, COMPLETE ALL ENTRIES, AND THEN SEND IT WITH A CHECK FOR AMOUNT
DUE MADE PAYABLE TO:

Californians for Disability Rights, Inc.
C/O Susan Chandler
1193 17th Street
Los Osos, CA  93402