Winthrop, Maine 1-800-273-5200

Membership Application

We encourage you to consider joining the Autism Society of Maine. The Autism Society of Maine is funded through its membership, donations, DHHS, and a variety of private foundations. Our mission at ASM 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 annually. The fee structure for your membership is below. If you have any questions regarding your membership, please call: 1-800-273-5200. By becoming a member of ASM, you will receive the following:

  • All affiliate benefits including our lending library, scholarship program for families/professionals, Autism Information SpecialistProgram and many more services.
  • The quarterly newsletter Maine Autism Connections.
  • First consideration for the Family Retreat and our 2 Summer Camps.
  • Voting privileges at the Annual Awards Banquet, voting in the Board of Directors.

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

Do you wish to have your newsletter delivered via email?   Yes

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)
Does individual or child with ASD have another diagnosis?
No
Yes
     (diagnosis)
Please give information about the individual with ASD:
First Name - Middle Initial - Last Name:
- -
Gender: Male
Female
X
Date of Birth:

CAPTCHA




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