Individual            $20                                          Return to:        APPA

 Family                 $40                                                                 P. O. Box 245

Corporate            $75                                                                 Cumming, GA 30028

Lifetime                $400

Additional Contribution _____                             Make checks payable to:  APPA 


Name(s) ____________________________________________________




City State Zip________________________________________________




Email Address_______________________________________________≠_


Please circle one.

  1. I am a new member
  2. I am renewing my membership
  3. Iíve already sent my tax-deductible annual membership contribution, but my contact information has changed as shown above.
  4. I am unable to contribute at this time but would like to receive the APPA News


Annual contributions help to educate the public and health care community concerning polio.  We respond to the needs of individuals who suffer from post-polio syndrome through group meetings, educational programming, newsletters and advocacy.  APPA is a 501C3 nonprofit corporation.  All contributions are tax deductible.


We need you!  Would you be willing to serve APPA in any of the following areas?

Membership outreach (phone calls to shut-ins) ________________________________

Newsletter (write articles, proof read) _______________________________________

Public Relations ________________________________________________________


Program planning _______________________________________________________

Data base assistance _____________________________________________________

APPA phone tree help____________________________________________________

Assist with answering APPA phone line _____________________________________

Planning a conference ____________________________________________________

Assist with social events __________________________________________________