Autism Pensacola Sustaining Membership 2024

Autism Pensacola Sustaining Membership

Become a 2024 Autism Pensacola Sustaining Member (monthly donor) by completing the form below. All sustaining memberships holders will receive a car magnet and shirt that will be available in our office March 2024.
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Your connection with autism

I am an individual on the spectrumI have a family member on the spectrumI am a professional serving individuals with autismI am a Community friend & supporter
I am also interested in helping Autism Pensacola as a volunteer.

I am an individual on the spectrumI have a family member on the spectrumI am a professional serving individuals with autismI am a Community friend & supporter
Name & date of birth of individual(s) on the spectrum
Which programs and services would best serve your membership?

Autism Education & TrainingCampsRespite OpportunitiesSupport GroupsSafety InitiativesSocial Events/OpportunitiesOther
If you selected other, please tell us how we can best serve you:

Sustaining member monthly donations

$10 Monthly DonationMembership Perks: VIP Event Notifications, Waived Application Fee to Kids for Camp, (4) Complimentary Respite/Event Tickets or (2) Adult Cooking Classes, Autism Pensacola T-Shirt & Car Magnet.

$10.00 for each month

$25 Monthly DonationMembership Perks: VIP Event Notifications, Waived Kids for Camp Application Fee, (6) Respite/Event Tickets or (3) Adult Cooking Classes, Autism Pensacola T-Shirt & Car Magnet, and a Holiday Gift Card for a family in need in your name.

$25.00 for each month

$50 Monthly DonationMembership Perks: VIP Event Notifications, Waived Kids for Camp Application Fee, Unlimited Respite/Event Tickets or (6) Adult Cooking Classes, (2) Autism Pensacola T-Shirts & Car Magnets, and (2) Holiday Gift Cards are given to families in need in your name.

$50.00 for each month

$100 Monthly DonationMembership Perks: VIP Event Notifications, Waived Kids for Camp Application Fee, Unlimited Respite/Event Tickets or (10) Adult Cooking Classes, (2) Autism Pensacola T-Shirts & Car Magnets, and (4) Holiday Gift Cards are given to families in need in your name.

$100.00 for each month

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

T-Shirt Sizes (Adult Small-3XL)
Autism Pensacola does not sell or provide your information to anyone without your prior written consent.

Yes, please include me on your email list of upcoming events and other Autism Pensacola notifications.No, please do not include me in your email list.
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