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Celebrating 58 Years!

Membership & Sponsorship with Arc of the Mid South
The Arc of the Mid South is a community organization serving individuals with developmental disabilities and their families. Your membership affirms and supports the programs and services of this organization.

Name
Address
City
State
Zip
Phone
Date	(MM/DD/YYYY)

	Please answer the following questions:
1.	Memberhsip New Member Renewing Member Associate Member
2.	Membership Type Student, Senior Citizen, Self advocate $10.00 Individual $25.00 Family $35.00 Corporate memberships available*
3	Comments *Click here for Corporate Membership form

	Make checks payable to Arc of the Mid South After you have completed this form you can print and mail to: Arc of the Mid South 3485 Poplar Avenue, Suite 210 Memphis, TN 38111 Phone: 901-327-2473 Fax: 901--327-1197 or Submit it via e-mail by clicking on the submit button. If you feel any of the above information is incorrect you may push the reset button and start filling out the form from the beginning.