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Fill out the registration form below, and mail it with your payment to:
The
Arc of Cowlitz Valley
1410 8th Avenue, Room #15
Longview, WA 98632
make checks payable to The Arc
Membership Registration Form
| ___$10 Self Advocate | ___$30 Individual | ___$40 Couple | ___$50 Organization | |
| Name___________________________________________ | Phone_____________________ | |||
| Address_______________________________________________________________________ | ||||
| Fax____________________E-mail______________________Web_______________________ | ||||
Dues include membership to local, state and national Arc