SDG Membership Form SDG Membership Form Date Today’s Date First Name * Last Name * Address * Address Street Address 1 Street Address 1 Street Address 2 Street Address 2 City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Phone Number * Email Address Emergency Contact Name Emergency Contact Phone Number I am (please choose one) * a person with a disability an ally I make my own decisions * Yes No If you checked No please provide the information requested below for the person (Guardian) who makes decisions on your behalf. Guardian’s Name Guardian’s Address Guardian's Address Street Address 1 Street Address 1 Street Address 2 Street Address 2 City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Guardian’s Phone Guardian’s Email When you click “Continue” you will be taken to our product page. From there click “Sign Up Now” to add your membership to your cart. Finally, click “View Cart” to proceed with payment. Continue If you are human, leave this field blank.
