Membership Application

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You are cordially invited to become a Member of the Blue Water Center for Independent Living.  For $5.00 per year for an individual and $25.00 per year for an organization.  As a member you'll receive our Quarterly newsletter as well as all announcements of upcoming events and meetings.  You'll be entitled to a vote for members of the Board of Directors each year in October at the Annual Dinner/Meeting.  You may have the opportunity to be a Representative in activities of the community.  Your membership card shows you're supporting an organization whose mission is bringing everyone with a disability into the main stream of society, in making independent living in every possible case not just a hope, but a reality.

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Please provide the following contact information:

First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

What type of membership would you like?

$5, Individual
$25, Organization/Company


Please indicate any area, or areas of Volunteer work that might interest you (such as Advocacy, Housing, Recreation, Accessibility, Transportation, Housekeeping, Clerical, Publications, Fundraising, Computers, Teaching):



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Revised: 11/30/01

 

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Last modified: 11/30/01