FCSN > MassPAC > MassPAC 2018 Membership Application

Click here to download a Printable version: MassPAC 2018 Printable Application (PDF)

2018 Online MassPAC Benefits and Application Form 12/20 edit

Annual Membership for MassPAC @ Federation for Children with Special Needs FY2018 (July 1st through June 30th)
  • Membership Information

  • To send in your Purchase order please: Upload using the link below, Email: masspac@fcsn.org or Fax: 617-241-0330 Attn: MassPAC
  • Upload your Purchase order in PDF format. You will receive an invoice via email.
  • Please provide an email address(es) to receive your invoice.
  • Please inform us of any special instructions for your P.O. or invoice.
  • Have you been a MassPAC member before?
  • District Information:

  • Name of School District:School Mailing Address:District Website: 
  • Administrator of Special Education:Administrator Email:Administrator Phone#: 
  • SEPAC Information

  • SEPAC Name:SEPAC Email Address:SEPAC Website: 
  • SEPAC Officer Information

    Please enter contact information for the SEPAC Officers - the first three names will be invited to the MassPAC Listserve under Basic level of membership - all officers listed will be invited under the PLUS level of membership.
  • Name:Title:Phone#Email: 
  • Name:Title:Phone#Email: 
  • Name:Title:Phone#Email: 
  • Name:Title:Phone#Email: 
  • Name:Title:Phone#Email: