2008/2009 Membership Form
Name:
Address:
City/State/Zip Code:
Home Phone Number:
Cell Phone Number:
Email Address:
School(s) My Different Learner(s) Attend:
School(s) My Other Children Attend:
Would you like to be in a Membership Directory for publication? Yes No
Circle the areas you are interested in helping with:
Hospitality Library/Resource Information Newsletter Circulation
Mentoring Committee Disability Awareness Workshop Publicity
Friends Appreciation Awards (June) School Representative
Membership Camp Fair
Are you a: ___Parent ___Educator ___Other________________________
Other organizations you are associated with:
Donations in kind ____________ ($, time, copying, etc.)
Annual Dues are $20.00.
Please make checks payable to "Friends of Different Learners" and mail with a copy of this form to: Friendsof Different Learners, P.O. Box 233, Birmingham, MI 48012-0233.
Friends of Different Learners is a 501 (c)(3) tax-exempt organization.