Arkansas Chapter
American Parkinson Disease Association
MEMBERSHIP APPLICATION
*Dues are payable every year.
*It is a tax deductible donation.
*Membership is on a per family basis.
*YOUR ARKANSAS CHAPTER APDA MEMBERSHIP WILL HELP KEEP US
GROWING IN ARKANSAS.
(Donations are our only source of income.)
| _____ |
Gold Membership |
$200.00 |
| _____ |
Silver Membership |
$100.00 |
| _____ |
Sponsoring Membership |
$ 50.00 |
| _____ |
Supporting Membership |
$ 25.00 |
| _____ |
Basic Membership |
$ 10.00 |
Name________________________________
Address______________________________
City________________State____Zip_______
Print and mail membership form and check to: AR Chapter APDA, PO. Box 22445, Hot Springs, AR 71903