Confidential Request for Dues Adjustment

Please remember to print a copy of this form for your records.

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Please indicate the type of dues adjustment being requested:

Dues adjustments are generally temporary and renewable once, depending on the individual’s circumstances, and do not affect membership status or benefits unless otherwise noted. You may be asked to provide additional information and/or documentation. Information provided will be considered confidential. Please allow up to four weeks for review and notification of decision.

Questions: Contact us (M–F, 9 a.m.–5 p.m. ET) 800-ACP-1915 (800-227-1915), or direct at 215-351-2600.


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