Winthrop, Maine 1-800-273-5200

Membership Application

We encourage you to join the Autism Society of Maine. The Autism Society of Maine is funded through its membership, donations, the Maine Department of Health and Human Services, and a variety of private foundations. As a chapter of the Autism Society of America (ASA), our mission is to promote lifelong access and opportunity for all individuals on the autism spectrum so they can be participating members of their community. Education, advocacy, and active public awareness form the cornerstones of the Autism Society of Maine’s effort to carry forth our mission.

ASM membership dues are due yearly. The fee structure for your membership is below. If you have questions regarding your Maine membership, please call: 1-800-273-5200.

  • You will enjoy all affiliate benefits including our lending library, scholarship program for families / professionals, Autism Information Specialist Program, and many more services.
  • You will receive our quarterly newsletter Maine Autism Connections.
  • First consideration for Family Retreat or Camp Summit (summer day camp)

You may pay online by Visa or MasterCard or you may click here to download and print our membership application, which can be mailed to the address shown on the application.

Newsletter

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Membership Information

Membership Type:
(Please choose one)
New Membership     Renewal
ASM Membership: Family / Individual $25.00
Student / Teacher $25.00
Agency / Organization $200.00
Professional $150.00
Lifetime $1,500.00
Additional Donation:

Total Cost: $25.00

Member Information:

Agency or School Name:
Your Name:
Address Type:
Home Address
Work Address
Address:
Telephone:
Cell Phone:
Fax:
E-mail:
Please choose the category which best describes you:
Individual with ASD
Parent of a Child with ASD
Family Member
Professional
     (which profession)
Please choose the category which best describes the
individual or child with ASD:
Autism
Other/None
     (diagnosis)
Please give information about the individual with ASD:
First Name - Middle Initial - Last Name:
- -
Gender: Male
Female
Date of Birth:

Payment Information

Please review your information before submitting your membership application. It may take a minute for the submission to finish, so please only click 'Submit Membership' once. After your membership application has been submitted, you will be prompted to pay your membership fee using PayPal.
If you would like to become a member of national Autism Society, see their website at: www.autism-society.org