Florida Association on Higher Education and Disability (FL-AHEAD) Membership Application 2020-2021

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FL-AHEAD is a non-Profit Organization (501-C3) TAX ID: 26-3552306

The following form is for all new and returning members to the FL-AHEAD affiliate. The membership year lasts from July 1st - June 30th.

If you have any questions regarding the application or would like to request the form in an alternative format, please contact Ashley Gorion at Ashley.Gorion@ucf.edu

Email *

Name *

Title *

Institution/Organization *

Address *

Email *

Telephone Number *

Fax Number

TTY

Website

Membership Status *

New Member - Welcome to this great network of professionals!

Renewal - So glad to have you back!

Membership Category *

Membership period runs 7/1/20 - 6/30/21. Memberships will not be pro-rated.

Individual Professional ($25.00)

Institutional Basic - 3 Members ($70.00)

Institutional Plus - 5 Members ($100.00)

Associate ($35.00)

Pre-Professional/ Graduate Student ($15.00)

Student/Undergraduate ($10.00)

Emeritus Professional ($10.00)

What do you/your institution hope to gain from your FL-AHEAD membership this year? *

As an accommodation for a disability, please provide printed Association materials in (on):

Braille

E-Text

Large Print

Clear selection

Clear form

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