Florida Association on Higher Education and Disability (FL-AHEAD) Membership Application 2019-2020
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 Ashley Linder at
Ashley.Linder@ucf.edu
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Email address
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Your email
Name
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Your answer
Title
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Your answer
Institution/Organization
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Your answer
Address
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Your answer
Email
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Your answer
Telephone Number
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Your answer
Fax Number
Your answer
TTY
Your answer
Website
Your answer
Membership Status
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New Member - Welcome to this great network of professionals!
Renewal - So glad to have you back!
Membership Category
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Membership period runs 7/1/19 - 6/30/20. Memberships will not be pro-rated.
Individual Professional ($25.00)
Institutional Basic - 3 Members ($70.00)
Institutional Plus - 5 Members ($100.00)
Associate ($35.00)
Pre-Professional/ Graduate Student ($15.00)
Student/Undergraduate ($10.00)
Emeritus Professional ($10.00)
What do you/your institution hope to gain from your FL-AHEAD membership this year?
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Your answer
As an accommodation for a disability, please provide printed Association materials in (on):
Braille
E-Text
Large Print
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