ASCEND Group, Inc.
P.O. Box 531, Ardmore, PA 19003-0531

Note: This form is for "Professional" members. An “Educator” member is defined as an employee of a School District, Intermediate Unit, or private school (including religious institution) who is charged with teaching individuals with Asperger Syndrome or other Autistic Spectrum Disorders (ASD) academic, social, religious, or life-skills. For the sake of membership, the term educator also includes individuals employed by the above-listed organizations who are administrators, guidance counselors, or psychologists and who oversee or train those who directly instruct individuals with ASDs.

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Annual Professional Membership for ASCEND Group

Name:	________________________________________________________
Title/Specialty:	________________________________________________________
School/Organization:	________________________________________________________
Address:	________________________________________________________
City:	________________________________________________________
State:	______________________	Zip:	________________________
Phone:	______________________	Email:	________________________
Web address:	________________________________________________________

Dues/Donation	Amount	Total
Professional membership:	$150
Donation:	Please specify an amount
	SUBTOTAL

* An extra donation can really make a difference and could go toward the following: sponsoring a family, contributing to our library fund, paying some of our operating expenses (insurance, mailings, printing, stationery, supplies), and other areas that keep this organization up and running.

Make check payable to: ASCEND Group, Inc.
Send to: ASCEND Treasurer, P.O. Box 531, Ardmore, PA 19003-0531

ASCEND Group is a 501(c)(3) corporation. Donations are tax deductible and greatly appreciated. The official registration and financial information of ASCEND Group, Inc. may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement. 

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