NDAC Group Membership Application | National Down Syndrome Congress

Group or Organization Name*

Approximate number of members in your group or organization*

Is your group or organization Down syndrome-specific, Other disability, Cross-disability, or Other?*

Down syndrome-specific
Other disability
Cross-disability

Is your group or organization Local, Statewide or National?*

Please elaborate on any policy areas in which your group or organziation has interest. Do you have a particular mission, policy topic of interest, or focus?

Is there any other information about your group or organization that you would like to provide?

Do you give permission for NDSC to list your group or organization on the NDSC website and in other materials as an NDAC Group Memmber, and link to your webpage if applicable?

Yes
No

Does your group or organization have a website? If yes, please provide link.

Does your group or organization have a Facebook page or group? If yes, please provide link.

Does your group or organization use Twitter? If yes, please provide Twitter handle.

Group Contact Person (the contact person is the NDAC Group Member representative)*

First Last

Contact Person's Email*

Contact Person's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Contact Person's Phone

I understand that all of my group or organization's members are invited to become NDAC Members, but are not required to do so. Only NDAC Members and the NDAC Group Member Representative will be able to join the NDAC Facebook group and receive other benefits of NDAC membership.*

Yes, I acknowledge

I have reviewed the NDAC Terms of Membership for Group Members and my group agrees to participate in NDAC, in accordance with the terms specified therein.*

Yes, I acknowledge

I understand that our group or organization may leave NDAC at any time by giving written notice to NDSC Policy & Advocacy Team, by emailing Jawanda Mast, jawanda@ndsccenter.org.*

Yes, I acknowledge

I understand that NDAC Group Members must pay a yearly fee of $20. (NOTE: if your group or organization is a current NDSC Affiliate Program subscriber, this fee is waived)*

Yes, I acknowledge