ADC

I would like to become a member. My dues are:

Individual - 1 Year [$75]	Individual - 2 Years [$140]
Family - 1 Year [$100]	Family - 2 Years [$180]
Overseas - 1 Year [$125]	Overseas - 2 Years [$235]
Corporate - 1 Year [$500]
Student or Limited Income - 1 Year [$25]

I am very enthusiastic about ADC's vital work. Please accept my donation of:

$25 $50 $100 $250
Other $

Please charge my:

Visa Mastercard Am Ex

Account Number:

Expiration:

I will send a check, payable to ADC, by mail to: 4201 Connecticut Ave, Suite 300 Washington, DC 20008

Member ID [Renewals Only]

First Name:

Last Name:

E-mail Address: [Required]

Address:

City:

State:

Zip Code:

Country:

Home Number:

Fax Number:

Additional Notes:
("Power of One" participants please include the name of your ADC Sponsor)

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