Membership - Support Us

Join Us / Support Us

It only takes $10 to become a member of Brain Injury Alliance of South Dakota and to help make a difference for people in South Dakota who have been affected by brain injury. Joining does not require additional work from you, but it makes us a stronger and larger organization with a louder voice in South Dakota. Please print and complete the form below and mail to our address at the bottom of the page.

Membership Form

Fields denoted with an asterisk (*) are required.

Name: * ______________________________________________

Organization: __________________________________________

Street Address: * _______________________________________

Address 2: ____________________________________________

City/Town: * ___________________________________________

State/Province: * _______________________________________

ZIP/Postal Code: * ______________________________________

Work Phone: ___________________________________________

Home Phone: __________________________________________

E-Mail Address: ________________________________________

Membership Status
Are you a new member of the Brain Injury Alliance of South Dakota?

Yes [ ] No [ ]

Membership

Individual Annual Membership $10.00 [ ]

Updates and Information
I would like to receive updates and information on the Brain Injury Alliance of South Dakota in the following format:

Print [ ] E-Mail [ ]

Payment Method
Please send me an invoice [ ]

I have or will send a personal check to the address below [ ]

Brain Injury Alliance of South Dakota

PO Box 39

Pierre, SD 57501