For mailing purposes, please indicate:
Mr. & Mrs.
Dr. & Mrs.
Mr.
Mrs.
Ms.
Dr.

Member or Corporation:

Employer:

Spouse:

Spouse's Employer:

Address:

• City:
  
• State:
  
• Zip:
  

• Phone:
  
• Fax:
  
• Email:
  

Annual Dues for October 1 through September 30:
Partner (21-40 yrs of age) $35
Friend $45
Patron $75
Lifetime $500

Please indicate your areas of interest from the choices below:

Addressing/Mailing: Fun and social way to meet others!

Children's Enrichment/Entertainment: Supply the Childrens Center with cookies, birthday cakes or special outings. Fun way to provide the "little extras" for the children.

Hospitality: Provide refreshments for various special events throughout the year.

Children's Treatment Center Grounds: Plant flowers, weed and rake leaves.

Office Skills: Available on an on-call basis to assist with phones and other office duties at the Family Center.

Family Support Line: Receive training to "staff" support line in our call center or after office hours calls can be forwarded to your home!