Membership Application

EFECT
PO Box 2345
Lee's Summit, MO 64063
(816) 600-8395
info@efect.org

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Thank you for your interest in EFECT! Please make sure that payment is made below (scroll down past the membership form) using the PayPal buttons or sent to:
EFECT
PO Box 2345
Lee's Summit, MO 64063
Attention: Membership

***PLEASE NOTE!!! You must fill out a membership form and send a payment for your membership to be complete. It will not be complete if one of the parts is not submitted with the other.

Name(s):
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Address:
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City:
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State:
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Zip Code:
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Email Address:
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Cell Phone:
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Home Phone:
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Child's Diagnosis/Self-Advocates Diagnosis:
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Number of individuals in this Membership
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Individual Membership-$15.00
Family Membership-$25.00
Lifetime Individual Membership-$100.00
Lifetime Family Membership-$150.00
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Individual Membership $15.00/yr + $1.00 processing fee Family Membership $25.00/yr + $2.00 processing fee Lifetime Membership Individual $100 (processing fee waived) Lifetime Family Membership $150.00 (processing fee waived)

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EFECT - Encouraging Families with Exceptional Children Together
P.O. Box 2345
Lee's Summit, Missouri 64063
816-600-8395
Email: info@efect.org