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AOP Membership Form

Yes! I believe in AOP! Please accept my membership contribution at the level indicated below: (check one)

____ $ 25 - Individual Member

____ $ 35 - Family Member (2 adults residing in the same household)

____ $ 50 - Supporting Member

____ I am not interested in an AOP membership, but I would like to make a contribution in the amount indicated below. My check is enclosed.

Contribution in the amount of $ ____________

Optional: In memory/honor of ______________________

_____ I wish to receive a complimentary subscription to the Mature Messenger for my contribution of $6.00 or more.

Name ____________________________________________________________

Address __________________________________________________________

City _____________________________________ State ___________________

Zip+4 __________________ E-mail Address ____________________________

Telephone _______________ Fax Number _________________

Please complete and return this form to:
Action for Older Persons
30 W. State St.
Binghamton, NY, 13901.

We look forward to hearing from you and appreciate your generosity!