Membership form

Your Support Enables The Arc to:

Offer guidance to those who need help and those who want to help.

Educate the public on precautions that can be taken to prevent developmental disabilities.

Monitor state and national progress made in the area of inclusion, such as education, employment, community living and recreation.

Make the public aware of the needs, rights and abilities of people with disabilities.

The Arc of Schuyler is a local organization serving people with disabilities and their families.

If you are interested in supporting The Arc of Schuyler, please print out the form below and send it with your donation.

Please provide us with the following information:

I/We want to support people with disabilities. Please accept my/our gift in the amount of:
$10 $25 $50 $100 $250 $500 $1000 Other

Mr. & Mrs. Mr. Mrs. Ms. Miss

Name

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

E-mail

Please put my contribution toward:
           The Arc of Schuyler's General Operation
           The Arc of Schuyler's Endowment Fund
           The Arc of Schuyler's Tribute Fund (please fill out information below)

My Tribute is:

In Memory of In Honor of

Please send acknowledgement to:

Name

Address

City State Zip

Method of Payment (Please make checks payable to The Arc of Schuyler)

Credit Card Number Expiration Date

All gifts are tax-deductible. Unless indicated otherwise, donors will be considered members of The Arc of Schuyler and will be entitled to all the benefits of membership.

Signature:

The Arc of Schuyler ? 203 Twelfth Street Watkins Glen, NY 14891 ? 607-535-6934

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
E-mail