Name
*
Address
*
City, State, Zip
*
Phone No.
*
E-mail
Name of Person with Down Syndrome
Gender of that person
His/Her date of birth
Your relation to the person with DS
With your permission we wil print a brief introduction to you on the website. What would you like our members to know about you? If you would like a picture on the website please e-mail to downsyndromeofbcs@yahoo.com
For an individual or family membership the annual dues are $25.00
Yes
No
To be a FRIEND OF DS OF B/CS, the annual level of giving is $100.00. Business name/Name on website
Yes
No
To be a PARTNER OF DS OF B/CS, the annual level of giving is $200.00. Logo on website
Yes
No
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Home Page
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