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!
Email address *
First Name *
Last Name *
Street Address *
City *
State *
ZIP Code *
Phone Number *
Are you a CDPA Consumer? *
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.
If you are a CDPA Consumer, who is your Fiscal Intermediary?
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