Membership Registration

required fields
Name
Address
City
State/Province
Zipcode
Country
Phone
Mobile
Email
Retype Email
Spouse Illness(es) and Disability(s)
Status
Age Group
Membership Type
Check if interested in starting a WSA support group in your area.
Annual membership includes a subscription to Mainstay, all WSA mailings, and participation in regional support groups (where available), workshops, respite weekends, and conferences. Your dues also help underwrite the operating cost of our website, online support forum, and other support programs.
Membership Dues*
One Year $25.00 (outside USA, $30.00)
Two Years $45.00 (outside USA, $55.00) 		$
Supporting One-Year Membership
Additional Contribution $
Make note of the total amount and follow the instructions on the next page.
Comments and/or questions:

 

* No well spouse is denied membership due to financial hardship. If you cannot afford full membership dues at this time, please pay whatever amount you can afford.