Join Arizona Disability Advocacy Coalition (AZDAC)
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
If applying for an Organizational Membership, please also provide:
Organization Name
Organization Mission
Organization Website
Alternate Contact
First Name
Last Name
Alternate Email
example@example.com
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Membership Levels:
prev
next
( X )
Individual Membership
$20.00
$
20.00
Organization Membership | Budget Under $100K
$50.00
$
50.00
Organization Membership | Budget $100K - $249K
$100.00
$
100.00
Organization Membership | Budget $250K - $499K
$200.00
$
200.00
Organization Membership | Budget $500K - $999K
$350.00
$
350.00
Organization Membership | Budget $1M -$1.5M
$750.00
$
750.00
In-Kind Resource Contribution
Free
$
Free
Offline Resource Contribution
(AZDAC will reach out to you)
Free
$
Free
Payment Methods
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
In-Kind Resource Description (if applicable)
I certify that I/my organization supports AZDAC’s mission, vision, and values and will follow all membership guidelines. I further attest that I/my organization will make the required annual resource contribution.
*
Yes
Save
Submit
Should be Empty: