Autism Connection of PA Newsletter Fall 2019 | Page 13

Your membership has benefits! It supports our work in meeting the needs of Pennsylvania families challenged with autism spectrum disorders. It also keeps your organization “front and center” in the minds of those very families.

Member Benefits:

>Acknowledgment with a clickable link to your website in our quarterly electronic newsletter

distributed to over 14,000 readers

>Organization logo with link featured on our website

>Discount (25%) to advertise in our quarterly electronic newsletter

>Discounted exhibitor rates at Conference and Trunk or Treat

Organization/Corporate Partners Membership Dues: $400

Please complete the following:

Organization ________________________________________________________________

Primary Contact Name ________________________________________________________________

Address ________________________________________________________________

Phone # _______________________ Fax # _____________________________

E-mail ________________________ Website _____________________________

Send completed form with payment info to:

(Checks payable to Autism Connection of PA)

Autism Connection of PA, 35 Wilson St., Suite 103, Pittsburgh, PA 15223

Email Nicole Cannon– [email protected]– phone 412-781-4116

Credit Card (VISA, MasterCard) ________________________

Card # ___________________________________________

Name as it Appears on Card _______________________________________________

3-digit CID # ___________________

Statement Billing Address _________________________________________________________________________________

Expiration Date _________________

Authorized Signature _____________________________________________________

Organization Membership Form

2020