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Membership Form

To update our records and keep the mailing costs as low as possible, please return this indicating your membership preferences.

I would like continue membership where I  read newsletters via the web and receive updates via an announce-only egroups.com list (free) 
I would like to continue membership where newsletters and updates are mailed to my home/organization ($5/yr which covers xeroxing and mailing costs)
I would like to join an egroups.com listserv specifically for this group.  It is a closed list and only available to approved people.
I prefer not to continue membership with the Corvallis PDD/Autism Support Group at this time

I am a parent/guardian or family member or friend of a child/adult with ASD
I am a professional (please fill in organization)

I would like to make my name and address available to members only for bi-annual membership list.  This is another way for us to exchange information, ideas, or questions.
I am willing to donate time to the organization (fundraising, help send mailings, being part of a phone tree)

Please help us determine what you would like from the organization (rate each item from 1-not important  to  5-very important):

Monthly support meetings to exchange questions, ideas, frustrations 
Education/Speakers about ___________________________________
A unified membership to place requests with the School District/Early Intervention
A place to socialize with other parents of children with ASD (Autism Spectrum Disorder) via membership parties/barbeques
A way to find out about what is going on locally and in the state with autism issues

Name:_______________________________________________________

Organization (optional):_________________________________________

My email address is____________________________________________

Address:_____________________________________________________

City: ________________________________________________________

State: ______ Zip ___________ Phone number(s): __________________

Please make checks payable to: MaryJo Weaver
Mail to:

MaryJo Weaver
727 NW 32nd
Corvallis, OR 97330
Phone: (541) 757-2820

Internet: http://oregonautsim.com/corvallis

Email: watatown@yahoo.com

MaryJo Weaver 727 NW 32nd Corvallis, OR 97330 (541) 757-2820 watatown@yahoo.com