Become a Member

Membership Dues Form

dFs, by virtue of being a nonprofit organization, receives reimbursement from the PA Department of Public Welfare for certain stipulated operating expenses; however, other disbursements are ineligible for reimbursement. The purpose of this fund is to provide additional benefits to dFs recipients and to cover expensed not reimbursed by the DPW. All expenditures from this fund must be approved by the dFs Board of Directors.
Donation Amount*

This donation is my contribution to the dFs Membership Fund. (MINIMUM OF $10)
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Membership Renewal Radio Buttons
- Is this a membership Renewal?*
  - Yes
  - No
Donation Type Radio Buttons
- I'd like to donate to:*
  - Drop-In Center
  - Special Funds
Total
$0.00
You will be redirected to Paypal to complete your donation. If you want to make an offline donation - please download, complete and mail your Membership Dues Form
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Membersip qualifies you to vote at the annual election of board members and officers as well as vote on issues referred to the membership.

Please download & print this form and mail it with your check made payable to:

Diversified Family Services

P.O. Box 1027
5454 East State Street
Hermitage, PA 16148

Printable Membership Dues Form

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