AED Membership Form

Name:
Address:
City:
State/Province:
Country:
Postal Code:
E-mail Address:
Diocese:
Order:	Select one Laos Bishop Presbyter Deacon
If Deacon, Ordination Date:
If Deacon or in formation, Birth Date:
Type of Membership	Choose one Regular - $50 Student/Limited Income - $30 Sustaining Membership - $75 Supporting Membership - $150 Patron - $250 Life Membership - $1,000 12 Month Extended Life, 1st Year - $400 12 Month Extended, 2nd Year - $300 12 Month Extended, 3rd Year - $300
Recruiter's name:
Recruiter's order:
Recruiter's diocese:
Recruiter's e-mail:

Please complete and print this form and mail it with your check or money order to: AED Membership Office P.O. Box 1324 Paso Robles, CA 93447-1324