2021 Individual Member Form
Please complete this form to join CDPAANYS as an Individual Member.
Membership as an Individual Member is $25 for Medicaid consumers and $75 for the general public. Your membership status is valid for one calendar year after the join date.
As an Individual Member, you will receive member discounts to all CDPAANYS events, have access to regular meetings with CDPAANYS leadership, and acknowledged for your support of Consumer Directed Personal Assistance in New York State.
Join today!
* Required
Email address
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Your email
First Name
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Your answer
Last Name
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Your answer
Street Address
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Your answer
City
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Your answer
State
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Your answer
ZIP Code
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Your answer
Phone Number
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Your answer
Are you a CDPA Consumer?
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If your organization is a CDPA provider, you will be asked to complete the Provider Member application. Affiliate Organizations may not be fiscal intermediaries or licensed home care agencies.
Yes, I have Medicaid and use CDPA for my personal care needs.
No, I do not use CDPA for my personal care needs.
If you are a CDPA Consumer, who is your Fiscal Intermediary?
Your answer
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