OCASG Dues Renewal

OCASG 2017 Member Renewal

This page is for OCASG members who would like to renew membership for 2017. At the bottom of this form you will be requested to pay annual, tax deductible family dues of $20 using any major credit card. When your renewal is received, you will be sent an email notification and 2017 membership letter. Thank you for your support!

The Orange County Asperger's Support Group is a charitable organization under Internal Revenue Code (IRC) Section 501(c)(3). Our Federal Tax ID # is 26-3602167. Dues and donations to OCASG are tax deductible following IRS guidelines.

Your First Name *

Your Last Name *

Please answer the following questions regarding the person (yourself or family member) with Aspergers Syndrome, High Functioning Autism or PDD-NOS.

First Name *

Last Name *

Birth date (month-day-year) of person with AS/HFA/PDD-NOS

*

If a minor (under age18), name of parent/guardian. If not applicable, please put NA. *

What is the relationship of this person to you? (examples: "son" or "self"). *

Your Address 1 *

Address 2

City *

State *

Postal Code *

Your Phone (include area code) *

Your Email Address *

Diagnosis? *

Asperger's Syndrome

High Functioning Autism

PDD-NOS

Please make a selection below. You will be able to complete your transaction using any major credit card on PayPal. You do not need to have a PayPal account. *

Basic $20 Annual Membership

Silver $35 Annual Membership

Gold $50 Annual Membership

Platinum $100 Annual Membership

By clicking CONTINUE, you agree to the OCASG Waiver and Code of Conduct and acknowledge OCASG as witness.

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