WAPD Individual Membership Application

(Please fill out this online form with your membership information and make your donation online OR print it and send it to us by mail)

You can help push the [dis] away from the word and make it: [ABLE!]

Please Don't Turn Away!.....

Remember: Each of us is only 1/2 step away from so-called "disability".

Select Type of Membership	Suggested Donation
Regular and/or Sponsor Membership Will also be entitled to receive: (1) Eligible to win one of many prizes that will be given to regular/volunteer members, e.g., software, books, hardware, wheelchairs, cruises, etc. that "Partners" will make available. (2) E-Mail newsletter (3) Membership in "Beacon Club" (4) Priority assistance from various WAPD information & advocacy departments. (5) Membership card personally signed by The Chairman of WAPD Board of Directors. (6) Other specials for regular/volunteer members only.	Minimum Suggested Only $20.00 per year (U.S. Funds) WAPD needs / is counting on your support... NOW!
Volunteer Membership Must pledge/volunteer minimum of 20 hours per year. (1) Membership card. (2) Membership in WAPD "Motivators Club" (3) Priority assistance from various WAPD information & advocacy departments. (4) E-Mail newsletter. (5) Eligible to win one of many prizes that will be given to regular / volunteers members only. (6) Other specials for regular / volunteer members (7) Can be administratively upgraded to full "Regular" status for excellence as volunteer.
Life Time Regular Membership Can be paid in ten (10) monthly payments of $25.00 each or write the Membership Department for other arrangements.	Minimum Suggested $250.00 One Time Only!

Enter Your Name and Address Here!

*First Name :**
Middle Initial:
*Last Name :**
*Address :**
Address Line 2:
*City :**
*State/Province :**
*Zip/Postal Code :**
*Country :**
*Email :**
Day Phone:
Fax:
Date of Birth:	(YYYY-MM-DD)
	* Indicates Required Information
	(dis)ABILITY (Include Talents, Interests or Comments)

IF IT'S GONNA BE... IT'S UP TO ME/YOU! _TMneeds your help...NOW! Help break the (dis)... away and turn it into ABILITY... *Now!*
I wish to sponsor:	WAPD Regular Memberships at $20.00 ea.
I wish to sponsor:	WAPD Lifetime Memberships at $250.00 ea.
Other contribution: $

WAPD accepts CREDIT CARDS for ALL Membership Donations through PayPal. Just click on:the "Continue to Payment ->" Button on the next screen after you have filled out and sent this form. (Security guaranteed by PayPal)

Or If you prefer, Please mail checks or money orders in U.S. currency to the address below.

If you would rather not enter data via the Internet, please feel free to print this form, fill it out as required and FAX or mail it to us.

World Association of Persons with disABILITIES Happy Stickman On Crutch
5016 Alan Lane
Oklahoma City, Oklahoma 73135
(405) 672-4440
FAX (405) 672-4441

Thank you very much.