By completing this form, I am consenting to and giving IADAC/NIADA, its affiliates and subsidiaries, my permission to (until I give written notice to discontinue) contact me and provide information to me at the mailing and e?mailing addresses, telephone and fax numbers I have provided. I certify that (I am/we are) eligible for membership in IADAC. I understand that a portion of my dues will be used for lobbying activities as defined by the Revenue Reconciliation Act of 1993. It is estimated that the percentage used for such purposes will be 22.8%. This portion of my dues is not deductible as ordinary and necessary business expense. Contributions and/or gifts are not deductible as charitable contributions for federal income tax purposes.