Florida's Voice on Developmental Disabilities
Membership Application / Donation Form
 

(We accept payment by credit card or check through Paypal.
You may also send us a check through the US mail.
Payment instructions will be given when you submit the form below.)


 
Name:
Aassociation Name:
Address:
City:
State:
  Zipcode:
Home Phone:
Work Phone:
FAX:
E-mail:
Where family member resides: 
Age of family member:
US Congress Dist:
Fla. Senate Dist:
Fla. House Dist:
Willing to serve as a director? 
Yes No
Dues
Individual or Family:
($25.00/year) If extreme $$$ 

        hardship ($15.00/year)
Association membership:
($150.00/year)
Donations
If wish to make a donation, check here:
Yes No
If yes, how much?
Additional comments:

Make all checks payable to:
Florida's Voice on Developmental Disabilities
Mail to:

P.O. Box 24531
Fort Lauderdale, Florida 33307
(954) 975-5159

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