The Arc of Butler County
Membership Application

Name:
Address:
Address 2:
City:
State:
Zip Code:
Phone:
E-mail:

Select Type of Memberships and Dues:

Individual - $15

Family - $25

Donor - $30

Patron - $50

Honorary - $100

I do not wish to receive mailings

Make check payable to:
The Arc of Butler County
Pullman Commerce Center
112 Hollywood Drive Suite 202
Butler PA 16001