NAME ____________________________________________________
ADDRESS
____________________________________________________
____________________________________________________
PHONE NUMBER ______________________
E-MAIL ADDRESS ______________________
FAX ______________________
I want to join. Dues are $10 to $25 (as able to afford). I am enclosing
$_______
Mail to:
DISABLED IN ACTION of Metropolitan New York
P.O. Box 30954, Port Authority Station
New York, NY 10011