DSANI | Members

Become a Member

If you are interested in becoming a DSANI member, please print out the form linked below,
fill it out, and send it to the address specified.

or join online by filling the form below!

after you fill out the form you can use a credit card to pay or mail your payment to our office

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
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
Please choose type of Membership: please select how many years of membership:
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 other $
Opportunities for Involvement (optional) I would be interested in serving on the following volunteer committees: Programs Newsletter Fundraising/Buddy Walk Outreach Committee Other