ACCR Inc. MEMBERSHIP FORM


To become a member of the ACCR Inc., provide the information specified, print this form and mail it to the address at the bottom of the page with your contribution.

NAME:                                                                                                              

HOME ADDRESS:                                                                                           

CITY:                                                             STATE: ___   ZIP: __________

HOME PHONE #: (___) ______________   CELL #: (___) _____________

EMAIL ADDRESS: _____________________________________________

    □      $15 Student Membership

    □      $25 Individual Membership      □      $35 Family Membership

           $50 Sponsor Membership          □      $100 Benefactor

           $500 Reformer        □      Other Donation Amount: ________

 

Mail this form with your check to:

 ACCR Inc., P.O. Box 10746, Birmingham, AL 35202

 

Contributions to ACCR Inc. are not tax-exempt for federal income tax purposes.  If you would like to make a tax-deductible donation, please make your check payable to the ACCR Foundation or donate securely online by clicking here.