Greenwich, CT 06831 Please print this page, fill out the requested information, and send it via snail mail with an optional contribution. NAME:
__________________________________________________________________________ ADDRESS:
__________________________________________________________________________ PHONE:
__________________________________________________________________________ FAX:
__________________________________________________________________________ EMAIL:
__________________________________________________________________________ I wish to become a member of FAP.

There is an autistic member in my family. Relationship/age:______________

[ ] Autistic [ ] PDD [ ] Other

I have friends with an autistic member in their family.

I wish to become a FAP volunteer and offer my time.

Enclosed is my check for membership:
single/family $ 20 ____ Professional $100 ____

Enclosed is a tax deductible donation (optional):

[ ] $50 [ ] $100 [ ] $200 [ ] $500 [ ] $1,000 [ ] Other $__________ Please make checks payable to: Friends of Autistic People and return via snail mail to Brita Darany at the address above.