Become a Member

If you are interested in becoming a DSANI member, please fill out the form below. Your first year of membership is free. Membership renewel forms are sent annually via snail mail to all DSANI members in Feburary. Please do not use this form for renewal. Please contact the DSANI office is you have any questions.

Personal Information

Name(s)	Email Address
Street Address	City
State	Zip
County	Phone(s)
Choose Best Option
If you do not wish to have your name published in the DSANI Directory, please check the following on the right:		Name Address Phone Number

Children

If you are a parent, please complete the following information below on your child(ren)

Name	Date of Birth	Has Down Syndrome
Name	Date of Birth	Has Down Syndrome
Name	Date of Birth	Has Down Syndrome
Name	Date of Birth	Has Down Syndrome
Name	Date of Birth	Has Down Syndrome
Name	Date of Birth	Has Down Syndrome

Opportunities for Giving (optional)

I/we wish to support the Down Syndrome Association of Northeast Indiana with the additional tax-deductible contribution (as allowed by law) checked below:

$25
$50
$75
$100
$200
$500
$750
$1000

Opportunities for Involvement (optional)

I would be interested in serving on the following volunteer committees:

Programs
Newsletter
Fundraising/Buddy Walk
Outreach Committee

Download Membership Form

If you prefer it, you can download, fill out, and send this membership form (linked above) back to us instead of filling out the online form.

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National Down Syndrome Society Buddy Walk

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