GAI Membership Application

Membership Application
Personal Information:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Preferred Method of Contact*
Guardian Experience:
0 - 1 year2 - 5 years6 - 10 years10+ years
Professional guardian or guardian organizationFamily member guardianStaff for advocacy groupAttorneyGovernment workerOther
Please specify:
Membership Motivation:
What do you hope the association will provide to its members?*
How do you plan to contribute to the association?*
Declaration:
I, {name}, hereby declare that all the information provided in this application is true and correct to the best of my knowledge. I understand that any false information. may result in the rejection of my application or termination of membership. Membership dues are due within 30 days after application approval.
Please submit the applicaiton fee of $40 to the Guardian Association of Indiana, PO Box 1665, Columbus, IN 47202
Should be Empty:

Membership Application