SCADHH MEMBERSHIP ENROLLMENT

YES, I'd like to join!

NAME:_________________________________________________________________

ADDRESS:______________________________________________________________

CITY:_________________________ STATE:__________ ZIPCODE+4:_______ - _____

TELEPHONE:(_____) _____________________________ TDD( ) VOICE( )

TELEPHONE:(_____) _____________________________ FAX( ) PAGER( )

EMAIL : ________________________________________________

______ Regular - $20.00 - 1 year
______ Regular - $40.00 - 2 years
______ Student - $10.00 - 1 year (copy of school enrollment required)
______ Student - $20.00 - 2 years (copy of school enrollment required)
______ Golden (Age 50+) - $5.00 - 1 year (copy of ID is required for proof of age)
______ Golden (Age 50+) - $10.00 - 2 years (copy of ID is required for proof of age)

______ Regular "Leader Package" - $90.00 - 2 years
______ Student "Leader Package" - $45.00 - 2 years (copy of school enrollment required)
______ Golden "Leader Package" - $60.00 - 2 years (copy of ID is required for proof of age)

$_____ Total enclosed.

*NOTE: "Leader Packages" includes 2 year membership and Biennial Conference Fees. Anyone may join now but the membership clock doesn't start ticking until September 1, 1999 for those who join before this date.

METHOD OF COMMUNICATION

Different people with different types of hearing disabilities use different communication methods. Please indicate which communication method preferred to assist us in obtaining the proper transliterator(s) for our meetings and conferences.

[__] American Sign Language
[__] American Signed English
[__] Signed Exact English
[__] Rochester Method
[__] Cued English
[__] Voice Only
[__] Other : Please Indicate ________________________________________

SCADHH COMMITTEES

If you wish to serve in a SCADHH Committee, please indicate the committee(s) you wish to serve:

[__] Education Committee
[__] Employment Committee
[__] Legislative Committee
[__] Transliterator/Interpreter Committee
[__] Gay Lesbian Committee
[__] Racial Relations Committee
[__] Senior Citizen Committee
[__] Cochlear Implant Committee
[__] Recreation Committee

Print this page, fill it out, and send with check or money order.

MAKE CHECKS, MONEY ORDERS PAYABLE TO SCADHH

MAIL TO:
SCADHH
P.O. BOX 1892
Tustin, California 92781-1892

PLEASE ALLOW 10 BUSINESS DAYS FOR CHECKS TO CLEAR

WE WILL SEND YOU A LAMINATED MEMBERSHIP CARD AND A 'WELCOME' NEWSLETTER