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Print and complete this form and either bring it to a monthly meeting, or sent it to P.O. Box 3756 / Crofton, MD 21114.
  Donation
    Amount 
$25
$100
$200
$500
$1,000
other
Make this my monthly donation. We will automatically receive your gift each month. 

Enroll me in a giving society. Automatic with certain donation amounts.

Bronze ($100 Donation) 
     - Individual/family chapter membership
     - Chapter t-shirt
Silver ($200 Donation) 
     - Individual/family chapter membership
     - Chapter t-shirt
     - Chapter hat
     - (2) tickets to the chapter social outing
Gold ($500 Donation) 
     - Individual/family chapter membership
     - Chapter t-shirt
     - Chapter hat
     - (4) tickets to the chapter social outing
     - (1)ticket for the chapter raffle
Platinum ($1,000 Donation) 
     - Individual/family chapter membership
     - Chapter t-shirt
     - Chapter hat
     - (4) tickets to the chapter social outing
     - (1) ticket for the chapter raffle
     - (1) registration to the CHADD National 
        convention
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Anne Arundel County Chapter
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Children and Adults with
Attention Deficit/Hyperactivity Disorder
P.O. Box 3756
Crofton, MD 21114