Membership

The Link
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Membership Dues Invoice
2007 - 2008

(September 1, 2007 through August 31, 2008)

Agency Information:

Contact Name:

Agency Name:

Phone Number:   Ext:

Address:

Address 2:

Please send the HSAC "The Link" monthly newsletter to the following employees at our agency
(put in address ONLY if different that above)

Name:

Address:

Name:

Address:

Name:

Address:

Name:

Address:

The following employees want to attend these division meetings:

Health Division                                          Senior Division


Volunteer Division                                     Disability Division


Youth & Family Division

Our Agency would like to recommend the following for the HSAC general meeting:

Dues are: Agency's Fiscal Budget x .0005
(Maximum of $300.00 per agency)

Please Call me:

Yes

No



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Membership Dues Invoice 2007 - 2008

(September 1, 2007 through August 31, 2008)

Membership Dues Invoice
2007 - 2008