Membership Form

Thank you for your interest in DSAF Nebraska. To become a member please fill out the form below. Our membership fee is $10.00, and you will be directed to PayPal to pay with your credit card or your PayPal account or you can send us a check

Email*:	Password*:	Re-type Password*:

First Name*:	MI:	Last Name*:

Spouse Name:

Address1:

Address2:

City:	State:	Zip:

Home Phone*:
- -
Work Phone:
- -

Do you know a child with Down Syndrome?
Add Child

Would like to be on the DSAF volunteer roster?
Yes No If Yes, please select how you would like to help: Mailings Events Organizational Speaker Child care Student

Note: All fields marked by (*) are required fields.