Membership Form.  Please print this form.
New Member      Renewal
Mailing/contact information here.

Name  _________________________________________________

Street   _______________________________________________ 

             _______________________________________________ 

City, State  _____________________________________________________________

 Zip/Postal code  ________________________________ 

Phone  _______________________________________

E-mail  _______________________________________

              
                       Please select the membership level you are able to support:

Platinum:  $250 or higher  $_________________       
Gold:  $150        Silver $100      Professional:  $60    Family:  $40 
Basic Membership:  $25            Self Advocate/Student:  $15

 Thank you for you support!  Payment options include:

 Check or money order          Payable to:  The Arc of South Carolina

Credit card                                            MasterCard                          Visa
If paying by credit card, please complete the following:

Card #:   ____________________________________________ Exp. Date: __________________________________  

Name on card:  _______________________________________ Signature:  __________________________________   

Billing address:  _______________________________________________________________________________

City/state/zip:  ________________________________________________________________________________

Membership is deductible as a charitable donation. 

Please mail applications to The Arc of South Carolina at the following address:
___________________________________________________________________________________
806 12th Street, West Columbia , SC 29169 803/748-5020 Fax 803/750-8121