On-line Membership Application

Memberships are renewed January 1st, each year. Membership includes membership card, subscription to DSPM newsletter and discounts on conferences in Missouri. Please check with the DSPM website for more information on discounts. Make checks payable to Nodaway County Services/ DSPM

Membership Dues:

$10 for DSPM Membership- for individuals who work in a direct support role.             ___ DSPM Member ($10)

$25 for "Friends of DSPM"- for individuals who do not work in a direct support role.   ___"Friend of DSPM" ($25)

$50 for "Supporters of DSPM"- for agencies who support our organization.                  ___"Supporters of DSPM" ($50)

Name:_________________________________________________________________________________

Address:_________________________________________________________   Apt.:__________________

City:_________________________________________   State:____________  Zip:_____________________

Home Phone: (_____) _____-_________   E-Mail:_________________  Business Phone: (___) ___-__________

Agency:______________________________________   Address:____________________________________

Please fill out all above information and send the application and check to :

Direct Support Professionals of Missouri

P.O. Box 454

Maryville, MO. 64468

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