Membership Form: Non-Provider (Pay by Check)

Please complete the form below to become a SPADD member organization or renew an expiring membership. Once form is completed, mail or deliver the dues check made payable to SPADD to: SPADD Attn: Angela Easter, 3300 Northeast Expressway NE, Bldg 9, Atlanta GA 30341.

Step 1 of 4

Demographic Information

Organization(Required)

Primary Contact / Voting Member(Required)

First Last

Email Address(Required)

Enter the primary contact’s email address here. You will have a chance to enter additional email addresses for your organization later.

Enter Email Confirm Email

Website

Address(Required)

Street Address Address Line 2 City State ZIP Code

Additional Organization Contacts

As a SPADD member organization, you may add other employees so they can receive SPADD digital correspondence. Please list any additional staff names and email addresses you would like to add. Note: This field is for *new* additions; email addresses that already exist in SPADD’s system will not change.

Would you like to add more employee email addresses?

Yes

Name

First Last

Name

First Last

Name

First Last

Membership Form: Non-Provider (Pay by Check)

Demographic Information

Membership Level Details

Additional Organization Contacts

Membership Level and Dues Payment