Directions: Print this form,
then complete and mail it, along with your cheque made out to "Speaking
Differently" to the address at the bottom of the page.
Name: ญญญญ______________________________________________
Address: _______________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Telephone: ____________________________________________________________________________
Fax: ____________________________________________________________________________
Email: ____________________________________________________________________________
Please indicate type of membership:
AAC user Annual dues: $4.00
AAC user Annual dues: Unable to submit dues at
this time - no dues need be submitted*
Student dues: $5.00
Non-user Friend Annual dues: $10.00
Non-user Benefactor Annual dues: $50.00
Non-user Patron Annual dues: $100.00
Mail to:
Speaking Differently
c/o Department of Speech-Language Pathology
University of Toronto
160-500 University Ave.
Toronto, ON M5G 1V5
Thank you from Speaking Differently!