Individual Registration Please enter information in the form below to process registration for event Register for Annual Membership. Thank you for your interest in APRIL membership. As we work on updating our membership online system, please call the APRIL office 501-753-3400 if you experience difficulty or have questions about filing your membership. Thank you! First Name * Last Name * Organization Address * Address 2 City * Zip * State Phone * Email * Website URL Choose Membership Please review the different membership options below and choose the one (s) that best fits. Please note, some have votes in our annual elections, and some do not. non-voting memberships choose one Individual Membership who is not a consumer or individual with disability- $25 Organization Associate (Other organizations that do not meet the criteria to be a CIL or SILC organizational member)- $100 Voting Membership options Youth (ages 18-30 and individual with a disability: Voting) $10 Individual/consumer (Individual with a disability: Voting) $25 CIL or SILC with Core Budget of 1-100,000 (Voting) $100 CIL or SILC with Core Budget of 100,001-250,000 (Voting) $200 CIL or SILC with Core Budget of 250,001-500,000 (Voting) $300 CIL or SILC with Budget of 500,001-750,000 (Voting) $400 CIL or SILC with Budget of 750,001 + (Voting) $500 Additional Memberships Below you have the option of adding on additional memberships to your order for Satellite offices, or other individuals or youth your organization is sponsoring that is not yourself. Please note that additional satellite memberships do not receive their own vote. The vote goes to the main CIL office that is a member. Enter the number of Satellite Office Memberships ($25 a piece) Note that they do not get their own vote in elections Email address for Satellite office Individual Name City and State and main email address if different than above person's information Satellite office name, city and state More Information About You Do you provide IL services to persons in rural areas? Yes No What are your IL Strengths or the areas you could offer support to APRIL or other members? What are your top 3 IL concerns that you would like to see APRIL address or highlight?? If your youth program staff would like info on our youth coordinator peer group, enter their email here Do you transition individuals from congregate settings to the community? Yes No Payment Information Amount $ Payment Method * Paypal Payment/Credit Card Offline Payment Billing Zipcode* Credit Card Number* Expiration Date* 01 02 03 04 05 06 07 08 09 10 11 12 / 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Card (CVV) Code* Card Type* Visa MasterCard Discover American Express Card Holder Name*