Newsletter Annual Contribution

Check one or more boxes that apply to you.

SHHH, Everett Area Chapter meets monthly Sept. through June (with a picnic in August). The chapter sends out the "Hearing & Beyond"
newsletter on the same schedule. We need your support to keep the SHHH, Everett Area Chapter functioning. You can help us continue to support and educate people who are hard of hearing, with an annual contribution from you of:

5 New or 5 Renewal $13.00 for one person

5 $15.00 for a family (Annual Contribution)

You may also send in your SHHH membership through us. Check the box below

5 $25.00 to become a member of SHHH. This includes the "Hearing Loss" Journal plus other benefits.

Name:__________________________________________________________________

Address:________________________________________________________________

City:___________________________State_______________Zip Code_____________

Phone Number __________________________ TTY / VOICE (Please circle one)

E-mail Address _____________________________________________________

How did you learn about SHHH (Self Help for Hard of Hearing People)?

___________________________________________________________________

Please make the check to SHHH, Everett Area Chapter and mail it along this form to:

Annette Johnson, Treasurer
8521 238th St. S.W. #B
Edmonds, WA 98026

Thank you for your Contribution