Florida Association on Higher Education and Disability (FL-AHEAD) Membership Application 2021-2022
FL-AHEAD is a non-Profit Organization (501-C3) TAX ID: 26-3552306

The following form is for all new and returning members to the FL-AHEAD affiliate. The membership year lasts from July 1st - June 30th.

If you have any questions regarding the application or would like to request the form in an alternative format, please contact treasurer@flahead.org.
Email *
Name *
Title *
Institution/Organization *
Address *
Email *
Telephone Number *
Fax Number
Membership Status *
Membership Category *
Membership period runs 7/1/21 - 6/30/22. Memberships will not be pro-rated.
What do you/your institution hope to gain from your FL-AHEAD membership this year? *
As an accommodation for a disability, please provide printed Association materials in (on):
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