First Name

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Last Name

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Address

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City

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State

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Zip

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Phone

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Fax

E-mail

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I am a:

Parent Sibling Grandparent Other Family Member/Guardian

I am member of The Arc:

  Chapter Name 

Membership for non-members is $25 and will be billed to you

Participation Agreement
Please indicate below that you have read and understand this agreement.
"I understand that The Arc of NJ's Family Advocacy Program's mission is to advocate for statewide and national changes to public policy for individuals with intellectual disabilities and their families. I understand that the primary goal of the program is not to advocate for the immediate needs of my individual family member. I also understand that I must be a member of The Arc, must be a family member of an individual with a developmental disability, must have access to email, and will be expected to respond to Action Alerts in a timely fashion."

 I have read and understand the above Participation Agreement