Membership Matters, The Arc of California
Membership Form
*
indicates required fields
*
Name:
*
Street Address:
Address (cont.):
*
City:
*
State/Province:
*
Zip/Postal Code:
Country:
E-mail:
Age Range:
1 - 24
25-34
35-44
45-54
55-65
66-++
Classification of member:
Self-Advocate
Professional in the field of Developmental Disability
Interested Citizen
Parent/Relative of a Person with Developmental Disability
If Parent, age of person with Disability:
N/A
1-21
22-35
36-50
51-++
Want to receive the mailings?:
yes
no
state only
local/state/national
Telephone:
Want to receive annual invoice?:
yes
no
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The Arc of California, 1225 8th Street, Suite 350, Sacramento, CA 95814. Office (916) 552-6619, Fax (916) 441-3494
