Membership Form

Membership Form

Becoming a member is easy! Fill out the form below, press submit and make donation to The Arc of LaGrange County.
Name

First Name Last Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Type of Membership

Family ($25 / year) Individual ($20 / year) Self-Advocate ($5 / year)
Payments can be made via cash, check, money order, or by PayPal. Visist our websige, www.arclag.org, to pay online.
Which publication(s) would you like to receive?

“The Arc Today” & "Arc News in Indiana” “The Searcher” (Our Local Newsletter)
Are you a:

Parent / Relative Self-Advocate Professional In-Field Caring Citizen
If you marked parent/relative to the above question, what is the age of your child or relative?
A tax deductible donation of $50 or more will include a one year FREE family membership!
Additional Donation Amount:
Should be Empty: