Annual Membership Dues: Single $15 Couple: $25 Associate (under 18) $5
New Member Renewal Member#____________ ____________ ____________
Name________________________________________________ Name (joint)__________________________
E-mail address__________________________________________ Birthday(s)_______ _________ _________
Address _________________________________________________________________________________
City _____________________________________________ State ____________ Zip Code _______________
Phone ___________________________ Dist. # ___9_____ Exp. Date ______________ Yr. Pins ____ ____ ___
Are you a registered voter? Yes / No
Mail your check or money order (Not cash) to ABATE
of Arkansas, Inc., 18019 Amazon Ln., Little Rock, AR 72206
Please include your drivers license # on your
check.
If you do not receive your card in 30 days call
state office at 501-888-5893
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| Office Use
Only (All information treated confidentially) Dues paid date________ Amount
paid_______ |
ABATE Districts District 1: Little Rock District 2: Jonesboro District 3: Russelville District 4: Fayetteville District 5: Blytheville* District 6: Rogers* District 7: Yellville District 8: Carroll County District 9: Magnolia District 10: Hope District 11: Batesville District 12: Mid South District 13: North Central District 14: Hot Springs District 15: Randolph County District 16: Mountain Home * Inactive District |
ABATE of Arkansas
Address Change/Correction/Complaint Form
______ I have not been receiving my newsletter
______ I have moved. My new address and phone number are below.
______ Information on my membership card is incorrect.
______ Information on my newsletter label is incorrect.
______ Other (briefly explain)
Please print information below
Name_________________________________ PH#______________
Address_________________________________________________
City________________________ State________ Zip_____________
Please return this for to:ABATE of Arkansas,
Inc.,
18019 Amazon Lane
Little Rock, AR 72206
Print out these applications for State Membership and Change/Correction/Complaint by clicking "file" then "print" at the top of your browser.
