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Auxiliary to The Ability Center Membership Form

Auxiliary Membership 2022 – 2023

Annual Dues are: $40.00

*An extra donation of $10.00 or more will help us fund some of the programs that are in need such as: Assistance Dogs, Community Living, Assistive Technology/Medical Equipment, Scholarship Fund, and Independent Living.

Please print information as you wish to be listed in the directory.
Your Name*
First Name Last Name
Spouse's Name*
First Name Last Name
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone
Work Phone
Email*
- Active Member – I would enjoy assisting with Auxiliary projects.
- Supporting Member – I am unable to volunteer at this time
I am interested in participating in the following committees:*
- Fashion Show
- Member Communications
- Serve on Auxiliary Board
- Public Relations/Publicity
- Special Events
- Mailings
Membership Fee
Price:
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
A representative from The Ability Center to reach out to you to secure membership and payment. Thank you for your interest in the Auxiliary to The Ability Center.
Name
This field is for validation purposes and should be left unchanged.

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Auxiliary to The Ability Center Membership Form

Auxiliary Membership 2022 – 2023

Annual Dues are: $40.00

The Ability Center

Bryan Satellite Office

Phone: 419-885-5733
Fax: 419-882-4813

Translate This Site

The Ability Center

Auxiliary to The Ability Center Membership Form

Auxiliary Membership 2022 – 2023

Annual Dues are: $40.00

The Ability Center

Bryan Satellite Office

Phone: 419-885-5733 Fax: 419-882-4813

Translate This Site

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The Ability Center

Phone: 419-885-5733
Fax: 419-882-4813