Membership Application
Personal Information
* Login Name:
* Login Password:
* Retype Password:
* First Name:
Middle/Initial:
* Last Name:
Gender:
* Birth Date: / /
* Home Address:
* City:
* State:
* Zip Code: -
* Cell Phone (xxx-xxx-xxxx format):
* Email:

Employment Information

* Name of Employer or Company:
Web Site:
* Industry
Work Address:
City:
State:
Zip Code: -
* How did you hear about DYP

Demographics

Ethnicity (Check all that apply): African American / Black
Asian
Caucasian American / White
Hispanic / Latino
Middle Eastern
Native American / Alaska Native
Pacific Islander
Other
Marital Status:
* Number of years living in Metro-Detroit:
Name & State of your Hometown:
* City You Live In
* City You Work In

Annual Membership Fees
* Individual Membership is $40 Billed Annually Individual Membership - Standard Rate

MEMBERSHIP POLICY: DYP Memberships are billed on a recurring annual basis. Your membership will automatically renew on an annual basis after submission of your membership application (and you will be charged the renewal rate) until you cancel your membership. Membership dues are non-refundable once paid. 

* Please check the box to confirm your understanding with our membership policy
Donations to DYP are tax deductible. Please enter any donations you would like to give here::
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