Yes, I would like to join AKA!
      Enclosed is my check/money order for a one-year membership.

      Name _____________________________________________________________________

      Address __________________________________________________________________

      City _________________________________________ State ____ Zip ____________

      Phone ____________________________________________________________________

      E-mail ___________________________________________________________________

      Please check all that apply:
       [] Adopted Person        [] Prospective Adoptive Parent
       [] Adoptive Parent       [] Social Worker
       [] Attorney              [] Therapist/Counselor
       [] Birth Parent          [] Other _____________________________

      Check Level(s) of Membership:
       [] Individual New Member: $48/year
       [] Individual Renewal: $36/year
       [] Student: $30/year (include copy of current student ID)
       [] Additional Family Members: $12/person
          Name(s):____________________________________________________
                  ____________________________________________________
       [] Agency Membership: $60/year for 4 members
          Agency:_____________________________________________________
          Please list names & email address for each:
          Member 1:___________________________________________________
          Member 2:___________________________________________________
          Member 3:___________________________________________________
          Member 4:___________________________________________________
									
      I am interested in volunteering for:
       [] Education/Programming       [] Library
       [] Conference/Workshops        [] Membership
       [] Newsletter/Publicity        [] Fundraising
       [] Search Assistance

      May we welcome you in our next newsletter?     
       [] yes       [] no

      Make check/money order payable to Adoption Knowledge Affiliates
      and mail with this form to:
                Adoption Knowledge Affiliates
                P.O. Box 4082
                Austin, TX  78765-4082

      For more information:
      512-553-AKA0 (2520)   www.adoptionknowledge.org   aka@adoptionknowledge.org