Become a Member of DSACT

FREE Membership Request Form
Welcome to the Down Syndrome Association of Central Texas (DSACT) membership request page! As a member, you will receive free announcements on program services, special events, and the newsletter.

All the information below is for DSACT use only. Your information will not be provided to any other subscription list. All subscribers should expect a welcome e-mail within a week of subscribing. Thank you for your interest in the Down Syndrome Association of Central Texas and its services.

Name *

Spouse/Significant Other's Name *

Address *

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

County *

Phone Number

###

####

Spouse/Significant Other Phone Number

###

####

Email *

Spouse/Significant Other Email

Do you know Someone with DS *

Name of Person with DS

Relationship to Person with DS

Father, Mother, Grandparent, Aunt, Uncle, Godparent etc.

DOB of Person with DS

YYYY

Sibling's Names and Date of Birth

Would you like to receive a packet?

How did you find out about our organization (check all that apply)

Friend/Family

Hospital/Clinic (i.e. doctor, therapist, etc.)

Media (i.e. newspaper, TV, news broadcast, radio)

Publication (i.e. brochure, flyer, newsletter, poster)

School District

Website (i.e. internet surfing, our website)

Other (not listed)

Anything else you would like us to know?

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