Membership or Donation Form (U.S. Mail)

Use this form to send your membership, donation or information request by U.S. Mail.
Print the form and send with your check to the address below.

You and MADD … making a difference in Orange County!

The Staff and Board of Directors invite you to join us in our efforts … together, we do make a difference!

MADD membership is FREE as of September 1, 2003

[__]       Yes, I want to join MADD

Please accept my donation:

[__]     Donation: $ _____________

Name: ________________________________________

Company Name: ________________________________

Address: ______________________________________

City/State/Zip: __________________________________

Home Phone: __________________________________

Business Phone: ________________________________

e-mail address:  __________________________________

[__]     YES!  Please contact me so I can find out more about how to get involved with MADD Orange County!

MADD Orange County Chapter

Please call (714) 838-6199 for current mailing address or send e-mail.

This page is: http://www.maddorangecounty.org/membermail.htm