ALDA Puget Sound

Association of Late Deafened Adults

Membership Form I wish to become a member of ALDA Puget Sound

Name: ___________________________________________

Address:_________________________________________

City:_____________________________________________

State:___________________ Zip:_____________________

E-Mail:_________________________________________________

Phone: ________________________ TTY: Yes___ No____

Birthday: Month_____________________ Day:_________

Do you want your name and address printed in the Alda Puget Sound Membership Directory? Yes_____ No____

Please mail this form and your check payable to ALDA Puget Sound for dues in the amount of $15.00 to:

ALDA Puget Sound
20501 123rd St. Ct. E
Bonney Lake, WA 98391

If you wish to make a Tax Deductible donation along with your dues, please include the amount donated on the printed form. Thank you!