109 Highland Ave

      Needham, MA  02494

      Phone:  781 444-7778 

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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.

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

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