AAFA/NE MEMBERSHIP AND DONATION FORM
Please join or make a contribution to AAFA/New England now. You will receive useful benefits and know your contribution is helping others at the same time. Membership benefits include the informative New England ASTHMA & ALLERGY BULLETIN three times a year and notice of events. Please consider the magnitude of the asthma and allergy problem when you choose a category of support. Membership donations are tax-deductible to the extent allowed by law.
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TO JOIN: Either call 1-877-2-ASTHMA to charge on Visa or
MasterCard - or print this page and fill out completely. Please make
checks payable to AAFA/New England and mail to: Asthma & Allergy Foundation of America/New England Chapter 109 Highland Avenue Needham, MA 02494 ANNUAL DUES AMOUNT ENCLOSED: __$25 Regular Family/Individual __$50 Sustaining Member __$100 Sponsor __$100 Health Professional (Receive 50 copies of New England newsletter for your patients and a membership certificate for your office). __$250 Benefactor __$500 Patron __Other $___________ ___New Member __Renewal Name_____________________________________________________ Address___________________________________________________ City__________________________________State_______Zip_____ Phone_______________________________e-mail________________
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