MEMBERSHIP APPLICATION: I ask the Board of Directors to accept me as a member of A.H.D.U., Inc.

Enclosed is my application fee and if I am given notice of acceptance I will pay the annual dues listed below: NOTE, 3/5 of the Voting Membership shall be within the disabled community. Additional information may be required

(__) Voting application fee is $10 with annual dues of $25
(__) Non-Voting application fee is $5 with annual dues of $10

Name___________________________________________________________________

Address________________________________________________________________

PHONE:
Home _________________ Work _________________ E-Mail ___________________

Are you physically and/or mentally challenged? Yes (__) - No (__)

Employed? Yes (__) - No (__)

If Employed Who ________________________________

Where did you hear about AHDU : _____________________________________________

What can you bring to AHDU: ___________________________________________________

_______________________________________________________________________

Your Education __________________________________________________________________

Can you contribute? (Please Check)

(__) Volunteer Time _______________________________

(__) Financial Donation _______________________________

(__) Fund Raising Support _______________________________

(__) Other _______________________________

Your background in the community concerning non-profit organizational work:

_________________________________________________________________________

(__) Have you ever been arrested

Convicted of a crime?_____________

If yes, please explain________________________________________________________

Sign and date _______________________________