Register for Annual Membership - 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

Additional Email Address If Needed

Individual Name City and State and main email address if different than above person's information

Satellite office name, city and state for all additional offices

More Information About You

Do you transition individuals from congregate settings to the community?

Yes

Do you provide IL services to persons in rural areas?

Yes

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

Payment Information

Amount

Payment Method *

Paypal Payment/Credit Card Offline Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Choose Membership

Additional Memberships

More Information About You

Payment Information

Contact Information: