Membership

Autism Society
Membership

If you would like to join the Local, State, and National of the Autism Society click here

Note:  If you are outside of our affiliate area, but still would like to be a member of the Autism Society Greater Long Beach/San Gabriel Valley be sure to specify that on your application.
If you do not wish to join at this time and would like to be on our mailing list only, please complete the following information and return it to us with your check in the amount of $10.00 to help defray the mailing costs. 
 

Name (Please print clearly)__________________________________________
Address________________________________________________________
City, State, Zip___________________________________________________
Phone_____________________ e-mail_______________________________

 

 

 

 

 

Make check or money order payable to Autism Society GLB/SGV and mail with this form to: 

Autism Society GLB/SGV
8635 Greenleaf Ave. Unit B
Whittier, CA 90602

To pay by credit card:   __ Amer Ex      __ Master Card     __ Visa     __ Other____________

Number_________________________Name on Card____________________________

Signature____________________________________________Expires_____________