Membership Renewal

MEMBERSHIP CATEGORIES AND ANNUAL DUES (SELECT ONE)

__ Advocate - works in a paid or volunteer capacity to assist parents of children with disabilities in special education matters.
Annual Dues: $50.00

__ Attorney - has passed the bar regardless of the extent of their practice, if any.
Annual Dues: $150

__ Parent - has a child with a disability and does not fall into any of the other categories.
Annual Dues: $50

__ Other - please specify ____________________________________
Annual Dues: $50

Additional Donation (tax deductible) in amount of $_______________

Total enclosed $______________

Members who work for the same organization may renew at the individual rate or together at the organizational rate of $400. Each member must complete an individual application and submit it with the organization's payment.

Name: _____________________________________________

Organization: _____________________________________

Street: _____________________________________________

City: _____________________________________________

State, Zip: _____________________________________________

Telephone: _____________________________________________

Email: _____________________________________________

If you want to use an e-mail address other than the one above for the COPAA Listservs, please indicate below:
Listserv Email: ________________________________

Is this your:
______ Home address/phone ______ Work address/phone

COPAA's information and activities are communicated through the Internet. We cannot ensure you will receive notice of all COPAA events if you do not have an email address.

The member understands that any use or reproduction of documents provided on the COPAA website without COPAA permission is restricted to the individual's personal use or for use on behalf of a client to promote advocacy on behalf of a child with a disability. Any use contrary to the Mission and Purpose of COPAA is prohibited. Mass distribution is permitted only with express written consent of COPAA.

I certify that I am not employed by, or receive more than 50% of my income from state, intermediate or local education agencies, nor am I an attorney who represents or has represented such an agency within the past five years, nor am I a member of a school board. [School board members wishing to join COPAA should contact membership@copaa.org for more information.]

Signature: ___________________________________ Date: ____________________

Mail completed application and check made payable to COPAA to:

COPAA
PO BOX 6767
Towson, Maryland 21285

Membership questions should be directed via Email to membership@copaa.org