Become a Member - PossAbilities

Membership to PossAbilities is FREE!

What is a PossAbilities Member?
An eligible member is any individual with a permanent physical or intellectual disability and/or veteran as clinically diagnosed according to the Social Security Administration Blue Book Part A or Part B. A list of official impairments may be found at: http://www.ssa.gov/disability/professionals/bluebook/.

What is a PossAbilities Support Member?
Support members are able-bodied community members that would like to be part of the PossAbilities family. Whether you’re interested in volunteering, making a donation, or would just like to keep up with the current events of the program…we need support members! It is our support members that strengthen our program and enable us to provide opportunities for our members.

Membership is free of charge! Just fill out the form below to join!
Be sure to designate whether you are a member or a support member.

PossAbilities Membership Application

Membership Type - Select all that apply*
- Member
- Support Member
- Veteran
- Volunteer
- Peer Visitor
- Community Partner*
* Community Partners are considered supporters of the program and are not eligible for benefits. Benefits are only available to members with a disability or veterans. By checking this box your organization will be added to our mailing list only.
Name of Applicant*
First Last

If you are completing this application on behalf of someone else, please list name of disabled person here. Thank you.
Birthdate*
Month
Day
Year
Gender*
- Male
- Female
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone
Email*
Please use a different email address as we are having trouble sending our newsletter to @llu.edu addresses at this time. Thank you.
Clinically Diagnosed Disability*
How did you hear about us?
Signature*

I certify that the information I have given is true and accurate. In addition, my electronic signature verifies membership acceptance to join PossAbilities and gives you permission to take photographs of me or my dependent named above to serve the best interests of Loma Linda University Medical Center or any of its divisions or schools. Please sign by entering your full name in the box above.
Signature (Only For Members & Peer Visitors) If you are not disabled, please enter 'Not Disabled'*

I certify that I am eligible for membership in PossAbilities due to my permanent clinical disability which is among those listed in Part A or Part B of the official 'List of Impairments' found at http://www.ssa.gov/disability/professionals/bluebook/ Please sign by entering your full name in the box above.