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 NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / 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 online via: PayPal, Venmo or Credit Card. Visist our website at https://www.arclag.org/donate to pay online or fill out the information below.
Which publication(s) would you like to receive?

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

Parent / RelativeSelf-AdvocateProfessional In-FieldCaring 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!
If paying online via PayPal or Credit Card, type the Membership Fee you selected above in the box below along with any additional donation you would like to give to The Arc of LaGrange County (Example: 25.00, 20.00, 5.00, 50.00, 75.00, etc.). After you have entered the total amount, select Pay with PayPal to complete your payment online through PayPal or via Credit Card.

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USDTotal Amount for Membership Fee & Donations
Pay with PayPal

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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