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Paid Membership

Membership
A family membership covers all members per household.
Applicant Info
Name
Address, City, State, & Zip
Home Phone
Cell Phone
Alternate Contact Information
Alternate Phone
Email (Secondary)
Additional Family Members

Please complete this section to include additional household members on your 2019 DSA of NWI Membership.

PERSON 1

First & Last Name
Phone Number
Year of Birth
Disability
Disability Type

PERSON 2

First & Last Name
Phone Number
Year of Birth
Disability
Disability Type

PERSON 3

First & Last Name
Phone Number
Year of Birth
Disability
Disability Type

PERSON 4

First & Last Name
Phone Number
Year of Birth
Disability
Disability Type
PERSON 5
First & Last Name
Phone Number
Year of Birth
Relationship to Applicant
Disability
Disability Type
PERSON 6
First & Last Name
Phone Number
Year of Birth
Relationship to Applicant
Disability
Disability Type:
Important (Optional) Information

The following information is EXTREMELY IMPORTANT for funding purposes; however, optional and will be kept confidential.  This information is gathered for the purposes of applying for grants, which often times require DSA of NWI & Chicagoland membership data to the grantor to determine and/or approve the Down Syndrome Association as a qualified applicant.

Race/Ethnicity
Family Income /year
Father/Guardian:
Education Level
Profession
Mother/Guardian
Education Level
Profession
Waivers
*REQUIRED
Please Note:  The DSA of NWI & Chicagoland loves pictures.  We love sharing those pictures with the public (on social media, in newsletters and for marketing purposes) even more! 
*REQUIRED
Payment Information

If you have any questions please contact the DSA by phone at (219) 838-3656 or email at dsa@dsaofnwi.org.

*REQUIRED
*REQUIRED
Visa MasterCard American Express Discover
*REQUIRED
/
*REQUIRED
? Visa®, Mastercard®, and Discover® cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

American Express® cardholders
Your security code is the 4-digit code located above the actual credit card number on your card's front.

A membership entitles you to:

(Note: the DSA of NWI & Chicagoland reserves the right to cancel or change programs and events)

  • Participate in DSA of NWI age-appropriate social groups and activities
  • Attend FREE educational programs and workshops
  • Updated DSA website
  • DSA Social Media (Facebook, Pinterest, Twitter)
  • Enrollment in our Making Connections Tutoring Program (reading and math)
  • Chit Chat Speech Groups (all ages)
  • Lending Library-A place to check out books, DVDs and developmental games
  • Monthly Arts Abound Classes (all ages)
  • Birthday cards delivered to persons with disabilities during the month of their birthday
  • Eligibility to be included in DSA Give Back Program
  • Quarterly newsletters
  • Automatic enrollment in our email notification group
  • New Parent Welcome Packets for new babies and families
  • Summer Family Picnic
  • Fall Outing
  • Spring Egg Hunt
  • Open Play and Game Nights
  • Yearly Baby Shower
  • Tiny Tots Playgroup (0-4yrs)
  • Moms Nights (quarterly)
  • Dads Nights (quarterly)
  • Monthly signing class
  • Cooking Up Cooking Classes
  • Teen Stars Group (13&up)
  • S.M.I.L.E Group events (18&up)
  • Play & Grow Group (Ages 3-8yrs)
  • Respite Nights
  • Reduced registration cost for Awards Night, Holiday Party and Valentine’s Party

But most of all, a yearly DSA membership provides you with pride in knowing you are reaching out to new parents of children with Down syndrome, helping families connect with each other, and providing education and advocacy.

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