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Membership Application

Fields marked with * are required.

Membership Information

Please select the appropriate membership category.

Membership:

Contact Information

Please fill out your contact information. For US and Canada addresses, please select the state or province where your home is located. For International locations, please fill out "State/Province (Foreign)" entry box if needed.

First Name: Last Name: Email Address: Preferred Phone Number: Mailing Address 1: Mailing Address 2: City: State/Territory/Province (USA and Canada): State/Province (Foreign): Zip/Postal Code: - Country:

Automatic Membership Renewal

Automatically renew your membership for uninterrupted access.

By checking this box I authorize CHADD to charge my credit card for the amount listed above, and to renew my membership, without interruption, each year at the renewal rate for my member category. I understand that I will be charged immediately for this year's membership fee, that I will be notified before my credit card is charged in future years, and that I can cancel or activate my automatic renewal at any time.

Eligibility Requirements for $5 membership monthly payment option
By checking this box I authorize CHADD to charge my credit card monthly for the amount listed above. I understand that I will be charged immediately for this month’s membership fee, that I will be notified before my credit card is charged each month, and that I can cancel my membership after six months.

Local Chapter

CHADD has volunteer-managed chapters throughout the United States. Please select the chapter that is closest to you. If there is no chapter in your area or if you prefer not to join a chapter, please select “Do Not Affiliate” in the chapter territory drop-down. If no selection is made CHADD will assign a chapter to you.

Chapter Territory:

Promo Code

Have a promo code? (only one Promo Code may be applied to each membership)

Promo Code:

CHADD Member Login Information

Please create a Login Name and Password so you can access the members only portion of the CHADD website. There are additional valuable resources available exclusively to members that you can access through the website. The password must be at least 8 characters in length and include a number.

Security

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