Membership or Donation Form (U.S. Mail)
Use this form to send your membership request, donation or information request by U.S. Mail.
Print the form and send with your check to the address below.

You and MADD … making a difference in the Pacific Northwest!

The Staff and Board of Directors invite you to join us in our efforts … together, we do make a difference!

  MADD membership is FREE as of September 1, 2003

_____ I want to join MADD

     Please accept my donation:

Donation: $ _____________Community Action Site Name for donation (if any): _____________________________________

Name: ________________________________________

Company Name: ________________________________

Address: ______________________________________

City/State/Zip: __________________________________

Home Phone: ___________________________________

Business Phone: _________________________________

e-mail address:  __________________________________

_____    YES!  Please contact me so I can find out more about how to get involved with MADD in Washington and Oregon!

Local: (425) 251-5252
Toll Free: (888) 364-MADD