IDA MEMBERSHIP

 
NAME: First: Last:
ORGANIZATION:
   
RENEWAL: Yes No
ADDRESS: Street:
ADDRESS 2: Suite / Floor:
  City:
  State: Zip:

DATE OF BIRTH: Month: Day: Year:
TELEPHONE: Day: (area code) Evening: (area code)
  E-mail: Fax: (area code)
Dyslexic Family Member? (if applicable): Spouse Self: Child Sibling

CATEGORY:
 
YES, I would like to RENEW/REGISTER my membership in IDA at the membership level checked:
(check one only):
Individual                          $ 70
Individual / Sustaining       $150
Individual / Supporting       $300
Family                               $110
Institutional                      $295
Lifetime                           $2000
Corporate - Level 2           $295
Corporate - Level 2           $795
College Student                 $ 40
Retired                              $ 45
 

PROFESSIONAL INTEREST:
 
PLEASE, check the category that BEST describes your occupation or professional interest:
Advocate / Lobbyist Parent
Attorney Physician
College Student Psychologist
Corporation / Organization Reading Specialist
Educational Administrator Research / Educational
Educational Diagnostician Research / Medical
Individual with Dyslexia Special Education Teacher
Parent/Other Family Member of Individual with Dyslexia Speech - Language Pathologist
Educational Therapist Tutor
Teacher Secondary Other:
 
 

Membership Mailing List Rental

At times, the IDA membership list is made available to other
organizations whose products or services we think our members might find of interest. If you do not want your contact information included on these mailing lists, please check here.

LD Service Provider Database

IDA maintains a list of service providers for people who contact us for resources. If you would like to be on this list and receive an application, please check here.

Your listing will remain on the service provider list as long as your member ship is active.

 

PAYMENT METHOD Credit Card:
  Card Number:
  Expiration Date:
  Card Holder’s Name: