Please Print Legibly!

Circle: New or Renewal?  Circle: Single $20 or Couple $30 

(Add $5.00 for each ABATE of SC Patch)

Current Abate Card # _____________

Names: (A) ____________________  (B) __________________

Mailing Address:________________________ Ph # ________

City: _____________________  State:________________Zip_____

Chapter Joined: ______________________ or AT LARGE

Make checks payable to ABATE of South Carolina, Inc.

Mail Application and payment to:

ABATE State Membership

Attn: Dan Toth

125 Sugar Cane Court

Warrenville, South Carolina 29851