Join Our Club | Camille's Community of Friends

CLUB MEMBERSHIP FORM

Please fill out the following form to become a member of our free monthly subscription club. Once your form is submitted, we will contact you regarding the next steps for membership. Thank you for your interest in joining Camille's Community of Friends!

First and Last Name

Home /Mobile Phone

Email Address

Street Address (including city, state, & zip code)

Date of Birth (Must be over the age of 18)

How did you hear about us?

Do you have a diagnosed physical and/or intellectual disability? This is a requirement for membership.

Yes

If you answered yes to the above question, please describe your disability.

Do you have a doctor or educator (teacher, counselor, etc.) who can attest to your disability? Please, list contact person (Title, Name, Email Address)

Thanks for your submission!