To have your information listed in the AAD Membership Directory, complete the form below and submit it to us. By submitting this information, you give AAD full permission to list this information in the AAD Membership Directory. Each individual is responsible to notify AAD of any changes of this information. For more information, contact Ernest Northup at 501-246-8097 or aadtreasurer@sbcglobal.net.

Your name.
The name of your spouse.
Your street address.
Your city.
Your TTY number.
Your voice number (if applicable).
Cell Phone/Text.
Your fax number (if applicable).
Your pager number (if applicable).
Your video phone number or IP address.
Brand of video phone used.
By filling out this form, I authorize the information to be printed in the NEXT of the AAD Membership Directory and to remain in the Directory until I change or cancel it.