Become a Member!

This is not an interactive form, it must be printed and mailed or faxed.

Membership contributions are tax deductible, except for $2.00 for a one-year subscription to the Recovery Reporter. Memberships expire one year from the date of application. Recovery, Inc. is a non-profit organization and we rely on our members for support. We thank you. Please print and mail this form to headquarters ,or submit it to a group leader.

Date
Name
Address
City
State/Zip Code
New Renewal

Check type of membership desired, and enclose a check made out to Recovery, Inc. If you prefer, you may use your Visa or Mastercard (see form at bottom of page). You may print and mail this form, or request a similar form be
sent to you. The fax number for Recovery, Inc. is:

FAX: (312) 337-5756

The address for Recovery, Inc. is:

Recovery, Inc.
802 North Dearborn Street
Chicago, IL 60610.

Regular Member

$20.00 U.S. $30.00 Canada (or more)

Contributing Member

$40.00 U.S. $60.00 Canada (or more)

Supporting Member

$80.00 U.S. $120.00 Canada (or more)

Sustaining Member

$160.00 U.S. $240.00 Canada (or more)

Visa/Mastercard Payments:

VISA MasterCard

Card Number:

Expiration Date:

Name:

Signature: _______________________________

Date:

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