AAD Membership Application
Please
complete and return to AAD by
regular mail or fax
Membership Desired:
Group________________
Allied
________________
Individual ____________
America’s
Athletes with Disabilities
2813
Spindle Lane
Bowie,
MD 20715-2136
Phone: (301) 464-3776
Fax: (301) 464-3776
Email:
drwmson@aol.com
1. Organization:
2. Contact
Person: Title:
3. Address:
4.
Phone number:
Cell
Number: 5. Fax Number:
(
) (
) ( )
6. Website:
7. Email
Address:
www.
8. Are you a 501(c)(3)
organization? Yes
No
If yes, please
provide your IRS tax
identification number __________________
If
no, What is
your IRS Status?
_______________________________________
9. Are you
part of a larger entity including state or local government or
educational institution?
Yes No
If yes, describe
the larger entity? _____________________________________
10. How many
individual members do you have?
11. Is your primary
mission to serve individuals with disabilities?
Yes No
If
no, What is your
primary mission? __________________________________
12. What disability groups do you
serve? ______________________________
13. What is your scope of service?
National Regional
State Local
Please describe service and
geographic areas served.
14. Please attach
a description of your programs. Include any brochures, fact sheets or
other printed material. Materials cannot be returned.
15. Please attach
a listing of your disability sports, recreation and fitness activities
and events including dates and locations. Include all events
scheduled for the next 12 months and that occurred
during the last 12 months.
America’s Athletes
with Disabilities is a 501(c)(3) non profit organization with the mission to
promote and sponsor sports, recreation, leisure, health and fitness
events for children and adults with physical disabilities.
Notifications of membership status will be sent by mail to your address
as listed above. Final determinations of membership are the sole
responsibility of the America’s Athletes with Disabilities Board of
Directors. The granting of membership is for a one-year period and will
be renewed automatically upon the completion of one year unless notified
otherwise in writing. Membership does not
guarantee any
financial support or funding from
America’s Athletes with Disabilities. Organizations that are granted
membership agree to allow AAD to share information about their
disability sports, recreation and fitness
events through AAD public information, direct marketing or other
activities as being part of the Victory Games series of events.
Signature:
___________________________________________________
Name:________________________________________________________
Please print
name
Title:______________________________________ Date:___________
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