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ILO Event & Activity Waiver

CLICK HERE to access the ILO Event and Activity Waiver

This form must be completed in order for your self-advocate to participate in ILO events and activities or to meet with staff.
Email Consent
  • I OPT-IN to receiving email communication from ILO.

Emergency Contact Info:

Emergency Contact First Name
Emergency Contact Last Name
Phone

Payment Information

Donation Amount*
  • $180 Annual Community Group Dues

Auto-Renewal Policy: Membership will automatically renew on January 1st, and your payment method will be charged the $180 dues unless you cancel before December 1. ILO will send reminder notices in November.

Payment Contact Information

Country*
Email*
Confirm Email*
Phone*

 

New Member Information:

Please complete the additional information below so that we can provide the most appropriate information. This information will not be shared with any outside parties. (If you have already provided this information to ILO please proceed to the bottom of the page to complete your payment.) 

Parent/Guardian/Sibling (2) Info:

First Name
Last Name
Street Address
City
Zip
Email
Confirm Email
Phone

Self-Advocate Info:

SA First Name
SA Last Name
SA Age
SA Birthdate
SA Gender
SA Phone
SA Email

Independent Living Information:

Geographic Area of Interest for Independent Living:
Interested in Specific Building or Area?
Type of ILO Community:
Check all that apply
Anything else you think is important for us to know?

Contact Us:

In the meantime, if you have any questions please feel free to contact us:

 

Email: info@ilonow.org
Telephone: (202) 248-7113
Fax: (202) 248-7635


 

Payment Summary

Amount*
$
Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
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