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If you need assistance, please call the DSAWM office at 616-956-3488 and we can process your transaction over the phone. If you prefer to pay with a check, please mail the Membership Form and your check made out to DSAWM to 160 68th St. SW, Suite 110, Grand Rapids, MI 49548.

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General Information
Parent/Caregiver Name*
First Last
Spouse/Partner
First Last
Address*
Street Address City State ZIP Code
County
DSAWM uses this information for programming and grant purposes.
In what county do you reside?
School District
DSAWM uses this information for programming and grant purposes.
Primary Email*
Spouse's/Partner's Email
Primary Cell Phone*
Spouse's/Partner's Cell Phone
Home Phone (if applicable)
Individual with Down syndrome Information
If more than 2 individuals with Down syndrome, please add the name, gender, and birthdate of any other individuals in the Additional Comments box below.
Name of Individual with Ds
First Last
Gender
- Male
- Female
Birthday
Which of the following best describes the individual with Down syndrome?*
- Asian or Pacific Islander
- Black or African American
- Hispanic or Latino
- Native American or Alaskan Native
- White or Caucasian
- Multiracial or Biracial
- Other
- Prefer not to answer
Other (please describe)
- Add another individual with Down syndrome
Name of Second Individual with Ds
First Last
Gender
- Male
- Female
Birthday
Which of the following best describes the individual with Down syndrome?*
- Asian or Pacific Islander
- Black or African American
- Hispanic or Latino
- Native American or Alaskan Native
- White or Caucasian
- Multiracial or Biracial
- Other
- Prefer not to answer
Other (please describe)
Member Permissions
Contact Permission
- I give DSAWM permission to contact me via email (newsletter, event & program information, etc.)
- I do not want to receive information from DSAWM.
Photo Consent
DSAWM photographs participants at many member events, activities, and gatherings. Additionally, each year DSAWM sends out a call to members for their own photo submissions. Photos may be used in marketing and promotional materials, the DSA Press newsletter, social media, or on the DSAWM website.
- I give permission to the DSAWM to use photos of me, my child and/or my family
- I do NOT give permission to the DSAWM to use photos of me, my child and/or my family
Volunteer Opportunities
Our volunteer opportunities range from one-time projects to ongoing working committees. Please share how you are interested in helping and we will contact you with more information.
- Events
- Programs
- Parents for Parents Mentoring
- Community Relations/Outreach
Membership Options
This is a*
- New Membership
- Renewal
New Membership Acknowledgment*
The first year of membership is free for any individual/family who joins DSAWM. We will contact you at the end of the year at which point you are invited to renew your membership. Membership dues are $25 (in-area) or $20 (out-of-area) annually and include free access to all programs, events, and services.
- I understand
Would you like to be connected with one of our veteran parents who can answer your questions, share experiences, and offer support?*
- Yes, please!
- Not right now, thanks, but maybe in the future.
- No, thank you.
If yes, do you have any preferences that you would like us to consider when matching you with a parent?
(i.e. parent of an older/younger child, location, shared medical diagnoses, etc.)
Additional Comments
Membership Type*
- Renew Membership Annually
- 1 Year Membership
Select Membership Level*
- Family or Individual Within Service Area: $25.00
- Family or Individual Outside of Service Area: $20.00
Additional Donation
- $10
- $25
- $50
- Custom
Enter custom amount
Payment Information
TOTAL
$0.00
Credit Card*

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Billing Address
Same as Above

Street Address City State ZIP Code
Additional Comments

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General Information

Individual with Down syndrome Information

Member Permissions

Membership Options

Payment Information