Achieva Resources Corporation, Inc.
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Membership Application
Thank you for deciding to join our membership. We look forward to your support. Please take a moment and fill out this form so we can process your membership application. After the form is successfully submitted a payment page will appear. Your application is not complete until payment is made. Thank you for your support!
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Name
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First
Last
Address
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City
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State
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Zip
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Phone
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Email
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Membership Level
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Capital Endowment ($500)
Directors Club ($250)
Presidents Club ($100)
Executive Vice Presidents Club ($50)
Membership Single ($20)
Membership Family ($30)
Consumer Membership ($2)
My Age Group is
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1-24
25-34
35-44
45-54
55-64
66+
My interest in the Arc is
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Self Advocate
Parent/Relative of person with disabilities
Professional in Human Services
Professional in Education
Medical Profession
Interested Citizen
If parent, my child's age is
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1-21
22-35
36-50
50+
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Achieva Resources Corporation, Inc., P.O. Box 1252, 800 Mendleson Drive, Richmond, Indiana 47375
Phone: 765-966-0502 Fax: 765-962-3179