Exceptional Families Network Membership
NOTE:
In compliance with state and federal regulations, we are required to obtain personal information, in order to give you a discount on our services. Your information will be kept on the file and in strict confidence. Income must be verified annually. Please provide proof of family income, including but not limited to an income tax return, w-2 form, paycheck stubs, copies of your social security checks, or other checks you may receive.
Only family size and annual income will be used to determine eligibility and calculate your discount. Families will not be denied access due to inability to pay.
Email address *
Parent/Guardian Name *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Primary Phone *
Your answer
Membership Fees (please initial payment option): *
Household Size *
Your answer
Number of individuals above age 18 *
Your answer
Number of individuals below age 18 *
Your answer
I would like more information on programs in my community *
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