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Join Us Today!
Please complete, print out and mail this form with your payment to:
The Autism Society of Orange County

2907 N. Cottonwood, #1
Orange, CA  92865-1209

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To learn about the benefits of membership in the Autism Society of America/ O.C. Chapter
Note: All membership dues and contributions are tax deductible.
Thank You!

Please enroll me in one of the following membership options:
Student $20.00
Individual $30.00
Family $45.00
Agency $250.00
Lifetime $1,000.00
I would like to make a tax deductible donation...
Donation amount:
New or Renewal Membership:
New
Renewal
Please provide the following information:
Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail
URL
Please choose from the following categories to best describe yourself:
Parent
Educator
Family Member
Medical Professional
Service Provider
Individual With Autism
Employer
Other/ describe
Payment Enclosed:
Membership Fee:
Donation Amount:
 
Total:

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Autism Society of America - Orange County Chapter
Last revised: 2/17/1999

This site was designed and is maintained on behalf of the ASAOC by:
Hedy Hansen