Electronic Membership Application

The Electronic Membership Application below shows us your INTENT TO BECOME A MEMBER. Once this form is complete, ASM will bill you or you can call in with payment information. Your registration is not active until payment is received.

or you can print it off here to complete and mail or fax back to ASM's office.

Download the Printable Version of the Membership Application (PDF)

The Autism Society of Michigan relies on memberships and charitable donations to promote quality service for people with autism. Please click on one of the "Membership Application" options above and send us your membership application today! You can choose from several membership options.

Once your registration is complete. You will receive a letter and a membership card from ASM indicating your membership period and date of renewal. Use your card at events for special discounts.

Autism Society of Michigan (ASM) membership benefits include:

• 10% discount on ASM bookstore
  
• Discount on ASM conferences and trainings
  
• Quarterly ASM Newsletter
  
• Voting privileges for Board of Directors elections
  
• Representation on disability committees
  
• Use of ASM video and print lending library
  

Autism Society of America (ASA) membership benefits include:

• a discount on the Annual Conference fees
  
• The Advocate newsletter 4 times a year
  
• ability to join committees
  
• voting privileges for Board of Director elections
  

Electronic Membership Form

ASM & ASA Membership

To join the Autism Society of Michigan, the Autism Society of America, or both, please fill out the form below. Mark your membership option below.
Please fill out all fields. Required fields are marked with an asterisk (*).

I am interested in the ASM as a:
	-Choose One- Parent Professional Friend Relative New Member Renewal
Choose your member category from the list:
	-Choose Your Membership- ASM & ASA: Individual (Parent) $50 ASM & ASA: Individual (Professional) $150 ASM & ASA: Family $65 ASM: Individual (Parent) $20 ASM: Individual (Professional) $50 ASM: Family $25 ASM: Full-time Student $10 ASM: Agency Affiliation (group of 10) $250 ASA: Individual (Parent) $30 ASM: Individual (Professional) $100 ASM: Family $40
Individual Member Information
(Organizations call 517-882-2800 for more details.)
First Name:
Last Name:
Street Address:
Street Address (cont'd.):
City:
State:
Zip:
Home Phone:
Work Phone:
Fax Number:
Email Address:
Comments:
Preferred Response:	Email Phone Fax Mail
Membership Agreement
I understand that I will be billed by ASM for my membership:
	-Choose One- Yes
If you would like to send an additional donation to ASM, please include the amount on your check and send us a note to let us know. Thanks! Remember, you are NOT a member until you submit payment to ASM by check or money order. Click submit below to complete the process.