Join or Renew Membership

 

Start by determining your membership type and dues:

  • Individual Stakeholder/Professional/Consultant - $150.00
    For People NOT affiliated with a provider agency.
  • Service Recipient or Family Member of Service Recipient - $50.00
     For individuals receiving service or family member(s).
  • Agency - $350.00
    For individuals working at provider agency.

* indicates required fields

Your Name: *

Agency Name: *

Agency Contact People (if different):

Street Address 1: *

Street Address 2:

City: *

State: *    Zip Code: *

Daytime Phone: *

Fax:

Email: *

Website:

Vendoring Regional Center(s):

(For Agency Membership Only) Total number of people served: SLS    ILS

Geographic Coverage (Counties):

Services your organization provides (check all that apply):
ILS   SLS   Other:


 *

 

Submit your information with the button below. For payment you can continue on to PayPal, or mail a check to the address below.

Send checks to:
JNCS, ATTN: Jennifer Lengyel
1190 S. Bascom Ave, Suite 240,
San Jose, CA 95128

For additional membership information, contact your Membership Coordinators:
- 818-361-6400 X 122
- 408-293-5002 X 104