Friends of Ability Counts
Membership Application
Name: ______________________________________________________
Address: ____________________________________________________
Phone: _____________________ Best time to contact me: ____________
E-mail: ______________________________________________________
Yes! Friends of Ability Counts can count on me to become their newest "Friend" and to help in the following ways:
Member _____ ($20.00 per year)
Silver Member _____ ($40.00 per year)
Gold Member _____ ($80.00 per year)
Charter Member _____ ($160.00 per year)
Other _____________________________
I can donate my time to help with events _____
I have items to donate. Please contact me for details. _____
Please make checks payable to:
Friends of Ability Counts
P.O. Box 52508
Riverside, CA 92517
(Print this page and mail completed form)
Your tax-deductible contribution receipt will be sent to your address above, unless you otherwise note. If you provide us with an e-mail address you will receive a Newsletter, Minutes of Meetings, and a Calendar of Events.
Please join us by becoming a "Friend" today!
For more information, call:
Diane Razo (951) 734-6595 x2040 or Email
Anna Duvvuri (909) 369-8768
Thank you for your generous contribution!
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