Your Name
Professional Discipline
Agency Name
Mailing Address
City
State
Zip
eMail Address
Home Phone
Work Phone
Fax Number
Preferred Chapter Association
Northern Chapter
San Diego/Imperial County Chapter
Southern Chapter
River Valley Chapter (Sierra Mtns./Sacramento & Central Valley Regions)
By checking these options you may give your permission to:
IDA may contact me using my Fax number.
IDA may contact me using my eMail address.
IDA may share my address with related organizations.
Membership Category and Term
1 Year
2 Years
Agency (up to 3 Staff members)
$200
$325
Individual
$60
$100
Parent
$25
$35
Student (12 units minimum)
$25
