ASCEND Group :: The Asperger Syndrome Alliance for Greater Philadephia

Membership

Annual Professional Membership for ASCEND Group

Information provided to ASCEND is confidential and is not shared. However, we will publish this information in the ASCEND member family directory only if you indicate you'd like to be included in the box below. The annual member family directory is distributed only to fellow member families.

* mandatory fields
Select one:	New Membership Renewal
Main contact*:
Title*:
Organization*:
Address 1*:
Address 2:
City*:
State*:
*Zip:**
*County:**
Telephone*:
Email*:
Web address:
Specialty: (e.g. child psychologist, occupational therapist, etc.)*
Brief description of services: (40 words or less, to be published in ASCEND's Professional Member Directory)*
Additional employees to add to database to receive mailings from ASCEND:
Name
Title

Name
Title

Name
Title

Name
Title

Name
Title
Get involved:	Please contact me. I wish to volunteer.


Click the above button to submit your payment.

Online Payments - processed safely and securely via PayPal. There is no requirement to have, or sign up for, a PayPal account. Most major credit cards are accepted. Your private information will not be shared with any other person, group or organization. However, we will publish the above information in ASCEND's Member Family Directory unless you have indicated otherwise by checking "No, I do not want to be included in the directory."

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