Aging & Disability Professionals Association of Wisconsin
2018 Membership Application
Name:
Title:E-Mail:
Agency Name:
What county/counties/tribe does your agency serve?
Mailing Address:Physical Address:
City: Zip:
Phone: Phone for ADPAW Website:
Website Address to List on ADPAW Website:
Which best describes your agency:
Agency is a stand-alone department of county/tribal government
Agency is within a larger department. Name of Dept.:
Agency is a non-profit
Membership Type (Pick One):
General Voting Membership
Which one of the following BEST DESCRIBES your position? PICK ONE
Aging Unit Director (single or multi-county:)
ADRC Director (single or multi-county:)
Aging Unit DirectorAND ADRC Director (single or multi-county/describe: )
Aging Unit DirectorANDLocal ADRC Supervisor (describe:)
Tribal Aging Unit Director
Other: ()
My Aging Unit Director, ADRC Director, or Tribal Aging Unit Director is not a member and has chosen me as their designee
Associate Membership (non-voting, see description below)
The cost of dues for all levels of membership in 2018 is $75.00, ADPAW FEIN #39-1489434. Please make checks payable to: Aging & Disability Professionals Association of Wisconsin (ADPAW). Mailcheck with the completed application form to ADPAW Treasurer address below:
Michelle Pike, ADRC of Ozaukee County, 121 W Main Street, Port Washington, WI 53074
Persons Eligible for Membership:
1)General voting membership in the Association is open to individuals, whose primary purpose is to manage Older Americans Act and/or Aging & Disability Resource Center programs and services. (Examples: County/Tribal Aging Unit Directors, ADRC Directors, Assistant Directors, Local Aging/ADRC/Tribal Supervisors). An organization may have multiple general memberships. Membership is attached to a single position and automatically transfers to a new person filling the same position.
2)Associate membership (non-voting) shall be open to any individual, group or organization interested in the association’s work.
Membership shall be granted for one (1) calendar year upon payment of annual dues commencing the first month of the calendar year.