DSACO Membership Application
There is no membership fee and membership is open to anyone with
an interest in Down syndrome. 

Primary Contact Information

Country*
State / Province*
Address*
City*
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*
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Email*
Confirm Email*
Phone
County
Number in Household
Employed By

Secondary/Spouse Contact Information

Secondary Contact First Name
Secondary Contact Last Name
Secondary Contact Email
Secondary Contact Employer

Contact Method

Preferred Method of Contact
  • E-mail
  • Mail
  • Phone
OPT OUT:
  • Please remove me from all mailings

Information About Person with Down Syndrome

Name of Person with Down syndrome
Birthdate
Birthing Hospital
County of Residence
School District
If the parent, please list any medical conditions of the person with Down syndrome

Person with Ds Contact Information

Please complete the following if the person with Down syndrome does not reside with you.

Address
City
State
Zip Code
Email Address
Phone Number

Release

Release Approval*
  • I hereby grant the Down Syndrome Association of Central Ohio permission to send me printed materials, emails and other information related to its mission. I understand that I may "opt out" of receiving any form of communication, at any time, for any reason.
  • I hereby grant the Down Syndrome Association of Central Ohio permission to take photographs of all members of my family. I also grant permission to the Down Syndrome Association of Central Ohio to copyright, use and publish the same in print and/or electronically. I agree that DSACO may use such photographs with or without names and for any lawful purpose, including for such purposes as publicity, illustration, advertising and Web content.
Electronic Signature*

We will not sell or share personal information with third parties. We will use the information to contact you about services or events that relevant to Down syndrome. 

Additional Comments

Security Code