Providing advocate services for children
              with special needs.
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Education-A-Must
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Application Form
 
Details of our Membership Benefits

Fill out this form and print two copies, then hit Send. Retain one copy for your records, include the other with your check,  or credit card number and expiration date, and mail to:
Education-A-Must
PO Box 216
East Derry, NH 03041

Membership Application Form
First Name:
Last Name:
Street:
City, State, Zip:
Email:
Home Phone:
Work Phone:
Fax:
Check all that apply: Special Needs Adult 
Spouse of Special Needs Adult
Parent of Special Needs Child
Health Care Professional
Teacher or School Administrator
Support Group Leader
Annual Memberships: Individual Membership: $35.00
Family Membership: $45.00
Professional Membership: $55.00
Payment Method: Check ( make check payable to Education-a-Must Inc.)
New Member (Welcome!)
Renewal (Thank You!)
Would you like to make a financial donation to Education-A-Must Inc.?
YES, I want to help Education-A-Must support the needs of children/youth with special needs.

Please make checks payable to: Education-A-Must Inc.
Your donation is tax deductible!

Enclosed please find my contribution in the amount of: $15
 $25
 $100
 $250
Other:
Are you interested in doing volunteer work for Education-A-Must Inc.?
 YES, please contact me about volunteer opportunities with Education-A-Must Inc.
Thank You for your Support!

Remember to print two copies before sending, then mail one copy with your payment!
 
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