HEIGHTENED INDEPENDENCE
AND PROGRESS
Membership Enrollment Form
I am interested in joining in the work of Heightened Independence and Progress.
I am a new____ (or) ____ renewing member for the 2008 year.
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Name
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Street/Apt.#
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City/State/Zip
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Phone: please specify day, evening,
or both
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Membership Categories -- please
check the right category for you:
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Basic Member
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$15.00
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Contributing Member (for those who
want to give
“that extra something” to support
hip)
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$30.00
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Family Membership (including
consumer with a disability
who is the voting member)
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$20.00
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Student or Teen Member*
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$ 5.00
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Corporate Member (includes
non-profit and for-profit
agencies, businesses, and foundations)
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$50.00
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Life Member* *
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$500.00 and above
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I am including an additional
voluntary contribution of
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$
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Enclosed is my total remittance
(check preferred, payable to
hip).
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* Students/Teens: Students of any
age qualify. Please indicate the name of the school you are attending
______________________________
**Life Membership: A special
category for those who wish to make a significant financial contribution to the
advancement of independent living, for themselves, in honor of a family member
or friend, or simply to show their desire to help all persons with disabilities
in their effort to lead productive, independent lives.
Contributions to Heightened
Independence
and Progress are tax-deductible.
hip 131
Main Street, Suite 120 Hackensack,
NJ 07601
201-996-9100 (voice) 201-996-9424 (TDD) 201-996-9422 (fax)