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* Verification code

Note: The Verification Code is a three- or four-digit code on the back of your card, usually on or near the signature box.

* Amount

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I would like my donation to go towards:

	Individual Membership $50
	Become a part of the Voice of Recovery! Recieve a 10% discount on the Tuerk Conference registration fee (excluding walk-ins), email updates and action alerts, and more!
	Student Membership $35
	Become a part of the Voice of Recovery! Recieve a 10% discount on the Tuerk Conference registration fee (excluding walk-ins), email updates and action alerts, and more!
	Organizational Membership (budget up to $250K) $100
	Become an Organizational Member of NCADD-Maryland and receive a 10% discount on the NCADD-Maryland Tuerk Conference registration fee (excluding walk-ins) for one designated contact. Membership fees based upon size of last year's annual operating budget. As a member your contact may participate in any NCADD-Maryland program (including ATAC).
	Organizational Membership (budget up to $500K) $150
	Become an Organizational Member of NCADD-Maryland and receive a 10% discount on the NCADD-Maryland Tuerk Conference registration fee (excluding walk-ins) for one designated contact. Membership fees based upon size of last year's annual operating budget. As a member your contact may participate in any NCADD-Maryland program (including ATAC).
	Organizational Membership (budget up to $1M) $200
	Become an Organizational Member of NCADD-Maryland and receive a 10% discount on the NCADD-Maryland Tuerk Conference registration fee (excluding walk-ins) for two designated contacts. Membership fees based upon size of last year's annual operating budget. As members your contacts may participate in any NCADD-Maryland program (including ATAC).
	Organizational Membership (budget up to $2M) $300
	Become an Organizational Member of NCADD-Maryland and receive a 10% discount on the NCADD-Maryland Tuerk Conference registration fee for two designated contacts. Membership fees based upon size of last year's annual operating budget. As members your contacts may participate in any NCADD-Maryland program (including ATAC).
	Organizational Membership (budget up to $2M+) $500
	Become an Organizational Member of NCADD-Maryland and receive a 10% discount on the NCADD-Maryland Tuerk Conference registration fee (excluding walk-ins) for three designated contacts. Membership fees based upon size of last year's annual operating budget. As members your contacts may participate in any NCADD-Maryland program (including ATAC).
	Make a donation to NCADD Maryland
	Make a donation to help NCADD-Maryland raise public awareness of addiction issues statewide, and ensure that those affected by the disease have the resources they need for treatment and recovery.
	Associate Org: for-profit company serving the industry $750
	Become an Associate Organizational Member of NCADD-Maryland and receive a 10% discount on the NCADD-Maryland Tuerk Conference registration fee (excluding walk-ins) for two designated contacts. As members your contacts may participate in any NCADD-Maryland program (including ATAC).
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* I confirm that the following statements are true and accurate:

I am a United States citizen or a permanent resident alien.
This contribution is not made from the general treasury funds of a corporation, labor organization or national bank.
This contribution is not made from the treasury of an entity or person who is a federal contractor.
The funds I am donating are not being provided to me by another person or entity for the purpose of making this contribution.
I am at least 18 years old.