Subscription / Renewal

______________________________________________________________
Name of Subscriber

______________________________________________
Street Address/ P.O. Box / Apt.#

_______________________________________________
City, State

___  ___  ___  ___  ___ - ___  ___  ___  ___
Zip Code + last four digits

(______)____________________
TTY

(______)____________________
Fax

______________________________
E-mail

Check all that apply:
_____ for UAD Bulletin mailing list only
_____ for TTY directory                     
_____ for Jottings in the UAD Bulletin

Subscription by UAD Members - $15/year
Subscription by Non-UAD Members - $25/year
(UAD Membership Fee is $30/2 years)

Send BOTH your old and new addresses.

PRINT THIS FORM AND MAIL WITH MONEY TO:
Valerie Kinney, UAD Assistant Treasurer

5320 South 4100 West
Roy, Utah 84067-7727


Any questions may be emailed to vkinney@comcast.net

Remember, if you don’t send your change of address, you don’t get the UAD Bulletin.
(UAD Bulletins can NOT be forwarded automatically to your new address by the Post Office)
Let Valerie Kinney know every time you move!