November Discount Form
American Adoption Congress November New Membership Application
Join AAC to commemorate National Adoption Awareness Month

(Rates discounted 20% during November ONLY)
We welcome your new membership in the AAC!                  Please check all of the following which apply
 
   Adoptee   Foster Family
  Adoptive Parent                    Foster Family Member
    Adoptive Relative    Extended adoptive/foster family
     Birth/First Parent                   Professional
  Birth Relative   Organization
  Foster Child   Support Group
       
_________ Initial here(REQ) to state you have read and understand the AAC Code of Ethics:

 
Name:
 
Organization/Agency:
Position:
 
Address:
 
City:                       State: Zip/Postal Code:
 
Phone: (H) or (C) Email:                          




Billing Address: If different from Above
 
Name:
 
Address:
 
City:                       State: Zip/Postal Code:


AAC accepts Visa, Mastercard, Discover and American Express
 
Card#                                                            Exp
Date                                        
CSV#
(Back or Front


 
Full Name on card:
 
Referred by:
 



Type of Membership: Discounted 20% 
  Check
One
 
Membership Plan Regular Rate Discount Rate
  Individual $50.00 $40.00
      Student (copy of student ID)
Senior (62+ copy ID or License
Disabled or Veteran
$40.00 $32.00
  Household*
Search Group*
$60.00 $48.00
  Organization**
Agency**
$160.00 $128.00


* 2 membership conference discounts
** 5 membership conference discounts


Must be POSTMARKED by November 30
Mail to: AAC Membership c/o Susan Friel-Williams
2215 SE 3rd St . Cape Coral, FL 33990-1424