USAAA Membership Application for Non-Profit and For-Profit Organizations

MEMBERSHIP HAS BENEFITS FOR NON-PROFIT AGENCIES AND FOR-PROFIT ORGANIZATIONS. With a USAAA membership, approved non-profit and for-profit members receive 10% off a vendor exhibit booth* (purchase of an exhibit booth includes 2 complimentary three-day registrations for exhibit booth vendor for our annual international conference held in August) and exciting discounts on interventions available via the USAAA website.
*subject to availability

Please complete the USAAA membership application form below. To complete the application, please print the application (Click here for a printer friendly form) and mail or fax to the address or phone number below. Include your membership fee with the application or go to our secured payment site at http://usautism.org/store_membership.htm and complete the information online. Once payment is received and your application is received, we will notify you of your membership status.

Non-Profit Agency or For-Profit Organization Information

Organization Name:_______________________________________________

Address:____________________ City:________________ Zip:________

Phone:______________________ Fax:_________________

E-mail:______________________ Website:_________________________

Incorporation date:__________

Federal tax ID#:_____________

Mission:________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Products sold ____________________________________________________________

Contact Information

TITLE: _______________________________________________________
NAME: _______________________________________________________
ADDRESS: ____________________________________________________
PHONE: ______________________________________________________
EMAIL: ______________________________________________________

Executive Director or President)_________________________________________________________

Board Chair________________________________________________________________

Non-profit Agency and For-Profit Organizations memberships are renewable annually.

Submit completed application to:

US Autism and Asperger Association, Inc.
P.O. Box 532
Draper, UT 84020-0532
Telephone: 801-816-1234
Fax:1-801-816-1551
email: information@usautism.com

Visit www.usautism.org for more information about upcoming events,
volunteer opportunities, and the Annual conference.

Annual Membership dues:
For Profit organization: $250.00
Non-Profit organization: $100.00

For Sponsorship level contributions, please click here.

To complete the application, please print the application and mail or fax to the information above. Include membership fee with application or go to our secured payment site at https://www.merchantamerica.com/usaaa/echopay/ and complete the information online.

Thanks for your support of USAAA.

For office use only
Date received________
Payment____________
Entered_____________