Please fill out the form below and then press the "Bill My Card" button.
Your credit card number will be scrambled before transmission. Internet memberships are accepted and processed seven days a week.

Or by US POSTAL SERVICE: Complete the form below, print it out on your
printer then mail the form, with payment to:

Andersen DEANs
1900 Port Seabourne
Newport Beach, CA 92660

ALL DONATIONS ARE TAX-DEDUCTIBLE (non-profit tax ID 33-0754551).

Thanks to your generous contributions, the DEANS plan to spend $789 for every child at Andersen this year! (Two children = $1,578!)

For On-Line Membership, just press the appropriate button:

Bronze Member $420	Silver Member $695
Gold Member $1000	Platinum Member $1500
Diamond Member $2000

US Postal Form or Fax Form:
	Member Information
Your Name (Last):	_______________________	(Required)
(First, M.I.):	_______________________	(Required)
Company:	_______________________
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Address (Street):	_______________________	(Required)
(City):	_______________________	(Required)
(State):	_____	(Required)
(ZIP):	_________	(Required)
Daytime Phone:	(___) ____ - ______	(Required)
FAX #:	(___) ____ - ______
E-Mail Address:	_______________________
How were you referred to us?	_______________________
Please send a receipt for my tax records ____

Type of Membership

__________________

(Ex: Bronze)

Payment Method:	___________________________	(Ex: Visa)
	Credit Card Information:
Card Number:	____________________________
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Exp. Date:	___________________ mmyy or mm/yy

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