Thank
you for wanting to help
eliminate drunk driving!
New Hampshire
MADD
Membership
Application
Please
...
* print out this application
* complete the form
* mail the completed form and your donation to:
MADD,
New Hampshire
123 Goffe Street
Manchester, NH 03102
Membership
_____
$10 Senior Citizen/Student
_____
$20 Individual Member
_____
$40 Family Membership
_____
$150 Organizational Affiliate
_____
Victim or Family of Victim (No Cost)
Donation $ ______
____________________________________
Name
____________________________________
Address
____________________________________
City
State
Zip
(
_______ )_________-_________________
Phone
Yes
____ I am interested in being a volunteer.
100% of your dollars stay right here in your community,
working to stop drunk driving, support the victims
of this violent crime and prevent underage drinking.
