National Association of Christians in Special Education (NACSPED) Membership/Conference Application
Please complete this form online. Send your check via the Postal Service to: NACSPED P.O. Box 7415 Redlands, CA 92375 Make your check payable to NACSPED.
Name (First Middle Last)	Home Phone	Email Address
Home Address	City, State, Zip
Denomination	Ethnicity	Gender (M/F)
Highest degree earned	Current educational status completed education full time student part time student
Professional organizations	Credentials held	Number of years involved with persons with disability?
Which of the following best describes you? Special Education Teacher [default]      Mild/Moderate     Moderate/Severe     Other (please specify)   Parent of child with a disability Involved in ministry to persons with disability Without professional training in disability, but with interest and experience (eg. business person) Other professional (please specify)
Areas of interest	How did you find out about the organization/conferences?
Are you interested in writing for a NACSPED newsletter?	Are you interested in presenting at a NACSPED conference?	Would you like a NACSPED newsletter sent to your email address?
	Membership rates includes membership in NACSPED and the 2009 conference