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


HOME ADDRESS:                                                                                           

CITY:                                                             STATE: ___   ZIP: __________

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

EMAIL ADDRESS: _____________________________________________

    □      $15 Individual Membership      □      $25 Family Membership

           $50 Sponsor Membership          □      $100 Benefactor

           $500 Reformer        □      Other Donation Amount: ________


Mail this form with your check to:

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


Contributions to ACCR 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 visit their online donation page at