NADSP Membership Form DSP Level ($10/year) Direct Support Professional

Other Individual Level ($20/year) If your state has a NADSP chapter, you will receive dual membership in the state chapter and NADSP. The Other Professionals category is for those working in community human services, such as social workers, administrators, and health care professionals. Frontline Supervisor

Self-Advocate

Family Member

Other Professional (specify)

Affiliate Level ($200/year) For individuals, agencies, providers, associations and NADSP state chapters who wish to demonstrate a commitment to support the efforts of DSPs. Individual

Organization

Supporting Level ($500/year) For individuals and organizations dedicated to advancing the interests of DSPs and the people they support at the national level. Individual

Organization

Sponsoring Level ($2,000/year) For individuals and organizations dedicated to advancing direct support as an accepted profession at the national level and participation on the NADSP Advisory Committee. Individual

Organization

TOTAL ENCLOSED Make checks payable to NADSP. To pay by credit card, visit www.nadsp.org/membership/. (Discounts are not available with online payment.) Mail membership form and payment to: NADSP, 240 Washington Ave. Ext., Suite 501, Albany, NY 12203-0305 Name ________________________________________________________

Organization __________________________________________________

Address ______________________________________________________

City _______________________ State ____________ Zip _____________

Phone _______________________________________________________

Email ________________________________________________________