Membership Form - One Time Donation (2025)

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.Format: (000) 000-0000.

Your connection with autism

Name & date of birth of individual(s) on the spectrum

Which programs and services would best serve your membership?

If you selected other, please tell us how we can best serve you:

Autism Pensacola does not sell or provide your information to anyone without your prior written consent.

My Products

Friend of API

Membership Perks: Notary Services and VIP Event Notifications

$25.00

Family Membership

Membership Perks: Notary Services, VIP Event Notifications, Kids for Camp Eligibility, (2) Respite/Event Tickets, OR (1) Adult Cooking Class Annually.

$50.00

Connector Membership

Notary Services, VIP Event Notifications, Kids for Camp Eligibility and Discounted Camp Application Fee, (4) Respite/Event Tickets OR (2) Adult Cooking Classes, 2023 Autism Pensacola Car Magnet.

$100.00

Business & Community Leader

Membership Perks: Notary Services, VIP Event Notifications, Kids for Camp Eligibility and Waived Application Fee, (5) Respite/Event Tickets OR (3) Adult Cooking Classes, Name/Business Recognition on the Membership Webpage, and (1) Autism Pensacola T-Shirt and Car Magnet.

$150.00

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Business & Community Leaders Only

Shirt sizes available in Adult Small to 3XL.

Autism Pensacola Membership Form

My Products