Join CAIC


California Alliance for		*advocating with and on behalf of people with developmental and other disabilities and their families*
	Inclusive Communities, Inc.

Join C.A.I.C.

We are engaged in a struggle to change state policy so that all people, irrespective of their disability, will be supported to be valued members of their local communities.
And now, the Governor has proposed parental co-pays and a sweeping roll-back of In Home Support Services that threaten our rights and people.

Please join the California Alliance and get connected to ongoing information about the budget battle and receive action alerts that help each of us do our part, as we are able, to preserve the promise that people with developmental disabilities and their families will be supported to live a life of dignity and meaning.

C.A.I.C. Membership Application

Online Registration: If you plan to complete your registration online (paying by PayPal or Credit Card), please fill out this form, click 'Submit' and proceed to our secure payment server.

By Mail: If you are registering by mail (paying by check, money order or purchase order), please fill out this form and print it out before hitting 'Submit'. Please make checks payable to C.A.I.C., Inc. and send the completed Application Form to:

C.A.I.C., Inc.
1500 Howard Stree
San Francisco, CA 94103

APPLICATION FORM:

Contact information (items in bold are required):

*First Name*
*Last Name*
Title
Organization
*Street Address*
Address (cont.)
*City*
*State/Province*
*Zip/Postal Code*
Country
Work Phone	*(please provide at least*
Home Phone	*one telephone number)*
FAX
*E-mail*
Website Address.

Membership Level

If you are joining as an individual:

Individual Membership - $30 Annual Dues
Family Membership - $40 Annual Dues
Self-Advocate Membership - $15 Annual Dues
Professional Membership - $100 Annual Dues

If you are joining as an organization:

Member Organization - $200 Annual Dues
Supporting Organization - $1,000 Annual Dues
Contributing Organization - $2,000 Annual Dues
Sustaining Organization - $5,000 Annual Dues

If you are applying for Family Membership, please indicate the names of your family members (separated by commas):

Dues Waiver - Due to financial hardship, please consider a waiver of membership dues:

No, thank you
Yes, please contact me

Membership Agreement - As a member of the California Alliance for Inclusive Communities, Inc. (I) (we) support the Mission and Values of C.A.I.C. and recognize them as the governing principles of the organization.

Yes
No, I'll consider membership at a later date. Just put me on C.A.I.C.'s mailing list.

My Time - I take responsibility for the future of services and supports for people with developmental disabilities and their families. I know that if we all contribute, in at least a small way, we will build a future with hope. This is what I can do:

Yikes!: Life is in my face right now. But I know I have to do my part. I can set aside 15 minutes once a quarter to make a call or write a letter.
Coffee Break: I can set aside 15 minutes each month to make a call or write a letter where it counts the most.
Walk in the Park: I can set aside one hour a month to write letters, make calls, or even be counted at a hearing or demonstration.
Shake the Tree: I can help involve other people, organize a meeting in my home or organization, or set up a phone tree. I know, this might be more than a walk in the park.
Feet on Fire!: We've waited too long already! What can I do?

To help us better represent our membership, please check all that apply. I am a:

Person with a Disability
Parent / Family Member
Direct Support Professional
Educator
Provider
Service Coordinator
Advocate
Other

I plan to complete my membership application with a payment by:

PayPal or Credit Card Payment (click 'Submit' and proceed to our secure payment server)
Check, Money Order, or Purchase Order (print this form before submitting it, and mail the printed copy).

If requesting a waiver, please click "submit form," then exit from the next page.

Send mail to info@caic.org with questions or comments about this web site. Last modified: 09/13/08

Send mail to info@caic.org with questions or comments about this web site.
Last modified: 09/13/08