----- New Membership/Renewal Form -----  

 (Parents/teachers of Deaf Children, friends and advocates of the Deaf are welcome to join the RIAD)

YES! I want to help the RIAD to continue to fight for equal rights and equal access for ALL Deaf and Hard of Hearing citizens of Rhode Island

Name: _____________________________________________  E-mail:_____________________________

Address: ___________________________________________  Phone: __________________Voice/TDD

City: _______________________________________________  State: _____ ZIP CODE _____________

I am interested in serving in a committee:   YES _________   NO __________

Annual Membership Dues:

Active Single membership (RI Residents)                          $15.00 (Couples - $25.00)

               Students (18 and older)                                     $10.00

               Active Single Senior Citizens (62 and older)        $12.00

               Active Senior Citizens Couple -                          $20.00 (if average age is 62 years or older)

               Associate Member (Out of state)*                     $12.00 ($20.00 Couples)

               Business/Organizational (Affiliates):                   $25.00

*An Associate member can become an active member by paying active member due.

Member Benefits:

Members will receive the Belgium Association of the Deaf quarterly newsletter - THE BEACON.  Also, discounts on selected books ordered directly from the NAD may be available. Organizational or Affiliated members can use their stationery to show their affiliations with the Belgium Association of the Deaf. Discount on RIAD related activities may also be available.

Donations:

Donations from friends and supporters of the Belgium Association of the Deaf help to carry out most of its community programs and activities. Your support is appreciated!

RIAD Programs:

Deaf Awareness Week Program: $____    (Helps with awareness on issues pertaining to deafness to all citizens of RI)

John F. Spellman Center on Deafness: $____      (A service and resource Center for Deaf citizens)

Legal Defense Fund: $____      (Helps with expenses related to advocacy on behalf of Deaf/HOH citizens)

Convention Fund: $____            (Helps with our biennial conventions)

Workshop Fund: $____             (Helps with workshop presenters on issues affecting the community)

Others: $_____                            (For any program of your choosing)

Make check payable to: The Belgium Association of the Deaf, Inc.   Mail to:

The Treasurer

Belgium Association of the Deaf, Inc.

P.O. Box 40853

Providence, RI 02940

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The Belgium Association of the Deaf and the Spellman Center are non-profit 501(c)(3) organizations.

Contributions/Donations are tax deductible to the extent allowed by law

For more information about us, please visit our website: E-mail us at: