Member Registration

Please fill out this form to be added to become a member of HADSA and to be added to the contact list.

*Name

*Spouse’s Name

*Address

*City    *State

*Zip Code

Phone Number 

*Email

*Confirm Email

Do you have a child/relative with Down syndrome? Yes No

If yes, what is your child/relative’s name?

If yes, what is your relationship to the child/relative?

If yes, what is your child/relative’s birthdate?

Do they have any medical conditions that you are willing to be contacted by a family with a child with the same condition?

Yes No

Please list any medical conditions you would like to share here


Thank you