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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. |
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If you do not have the free Adobe Acrobat Reader
to access the PDF on the left,
click the icon below to download.
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| Mail or Fax application to: |
Recovery, Inc.
802 North Dearborn Street
Chicago, IL 60610
Fax: (312) 337-5756 |
| Date: |
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| Name: |
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| Street Address: |
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| City: |
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| State/Zip Code: |
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New membership
Renewal membership |
| 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. |
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Regular Member
$20.00 U.S.
$30.00 Canada (or more) |
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Contributing Member
$40.00 U.S.
$60.00 Canada (or more) |
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Supporting Member
$80.00 U.S.
$120.00 Canada (or more) |
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Sustaining Member
$160.00 U.S.
$240.00 Canada (or more) |
| Visa/Mastercard Payments:
Visa
MasterCard |
| Card Number: |
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| Expiration Date: |
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| Name: |
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| Signature: |
_______________________________ |
Date: |
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