Florida Association on Higher Education and Disability (FL-AHEAD) Membership Application
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 Nikkia Gumbs at nikkia.gumbs@saintleo.edu

Name *
Your answer
Title *
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Institution/Organization *
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Address *
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Email *
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Telephone Number *
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Fax Number
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TTY
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Website
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Membership Status *
Membership Category *
Membership period runs 7/1/18 - 6/30/19. Memberships will not be pro-rated.
As an accommodation for a disability, please provide printed Association materials in (on):
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