Become A Member of DSAV

We are so glad that you want to become a part of the Down Syndrome Association of the Valley. Please take a moment to fill out the form below and let us know how we can serve you and your family. E-mail us with any questions or comments.

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How did you hear about DSAV?
What services are most important to you?	(Please rate in order of importance, with 1 being your first choice) 1 2 3 4 5 Parent support meetings 1 2 3 4 5 Professional speakers 1 2 3 4 5 Age-based gatherings or playgroups 1 2 3 4 5 Phone support newtork 1 2 3 4 5 Advocacy Other
What topic(s) would you like to hear about or have information on?	(Please check all that apply) Special needs trust/financial planning Medical issues Early intervention Therpies - OT, PT, ST School inclusion/IEP's Adults with DS - independent living Parent open forum - general discussion Other
What area(s) are you able to be involved?	New parent support Phone calls Newsletter Mailings Meeting set up/tear down Event/meeting planning Fundraising Photography Other
About You
First Name	* Required
Last Name	* Required
Spouse's Name
E-mail Address	* Required
Phone	* Required
Street Address	* Required
City	* Required
State	- Select One - AL (Alabama) AK (Alaska) AZ (Arizona) AR (Arkansas) CA (California) CO (Colorado) CT (Connecticut) DE (Delaware) DC (District of Columbia) FL (Florida) GA (Georgia) HI (Hawaii) ID (Idaho) IL (Illinois) IN (Indiana) IA (Iowa) KS (Kansas) KY (Kentucky) LA (Louisiana) ME (Maine) MD (Maryland) MA (Massachusetts) MI (Michigan) MN (Minnesota) MS (Mississippi) MO (Missouri) MT (Montana) NE (Nebraska) NV (Nevada) NH (New Hampshire) NJ (New Jersey) NM (New Mexico) NY (New York) NC (North Carolina) ND (North Dakota) OH (Ohio) OK (Oklahoma) OR (Oregon) PA (Pennsylvania) PR (Puerto Rico) RI (Rhode Island) SC (South Carolina) SD (South Dakota) TN (Tennessee) TX (Texas) UT (Utah) VT (Vermont) VA (Virginia) WA (Washington) WV (West Virginia) WI (Wisconsin) WY (Wyoming) * Required
Zip Code	* Required
About Your Family Member/Friend With Down Syndrome
Name
Birthdate	Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Gender	- Select One - Male Female
Activities/Interests