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If you desire association or conference information E-mail, or fax to (601) 582-7715 or call 1-800-400-2883 for more information and conference packets. Conference is for ADRSA associates only.

Associate Application

First Name
Last Name
Mailing Address
City
State
Zip

Telephone	Area Code		Phone
Fax	Area Code		Phone

What profession are you licensed in?
Are you currently practicing as a Social Security disability representative?	YES NO
Regular Associate Price = $200.00.	Check to Agree
What type of Internet Browser do you use?	* Choose * Netscape Microsoft Internet Explorer Other
How are you connected to the Internet?	* Choose * AOL Compuserve MSN Local ISP Other