Down Syndrome Research Foundation

1409 Sperling Avenue, Burnaby
British Columbia, Canada V5B 4J8

email: info@dsrf.org

Membership at the Down Syndrome Research Foundation is available to anyone who shares our values and mission of maximizing the ability of people with Down syndrome to lead independent lives and to participate in the community in which they live.

Basic Membership .............................................................. $35.00 per year

As a DSRF Basic Member you will:

• receive our quarterly newsletter, Hand-in-Hand
• be able to borrow books and other resources from our extensive library
• be eligible for a discount on DSRF programs

Education Membership ....................................................... $50.00 per year

As a DSRF Education Member you will:

• receive our Basic Membership
• plus receive an electronic current awareness services, keeping you up-to-date and informed

Membership Registration

* NB: your name, province/state, country and email are required.
Personal Information:
Company Name:
Last Name*:
First Name*:
Street Address:
City:
Postal / Zip Code:
Country:	Please select...AlbaniaAmerican SamoaAngolaAnguillaAntiguaArgentinaArmeniaArubaAustraliaAustriaBahamasBahrainBarbadosBelarusBelgiumBelizeBeninBermudaBoliviaBosniaBrazilBritish Virgin IslandsBruneiBulgariaCambodiaCanadaCape Verde IslandsCayman IslandsChileChina, People's Republic ofColombiaCook IslandsCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDominicaDominican RepublicEcuadorEgyptEl SalvadorEritreaEstoniaEthiopiaFijiFinlandFranceFrench AntillesFrench GuianaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGrenadaGuamGuantanamo BayGuatemalaGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIrelandIsraelItalyIvory CoastJamaicaJapanKazakhstanKorea, Republic ofKuwaitLatviaLebanonLiechtensteinLithuaniaLuxembourgMacauMacedonia, Republic ofMalaysiaMaltaMarshall IslandsMauritiusMexicoMicronesiaMonacoMongoliaMontserratMoroccoNetherlandsNetherlands AntillesNew ZealandNicaraguaNigeriaNorwayPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaSaipanSan MarinoSaudi ArabiaSenegalSeychelles IslandsSierra LeoneSingaporeSlovak RepublicSolomon IslandsSouth AfricaSpainSri LankaSt. Kitts and NevisSt. LuciaSt. Pierre and MiquelonSt. VincentSudanSurinameSwedenSwitzerlandSyriaTaiwanThailandTrinidad and TobagoTurkeyTurks and CaicosUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUSAUzbekistanVenezuelaVietnamYemen, Arab Republic ofZambiaZimbabwe
Province/State:
Home Phone:
Work Phone:
Cell Phone:
Fax:
Email Address*:

Additional Information (optional):
Are you a parent of a child with Down Syndrome?:
Yes	No
If yes...
Child's Name:
Date of Birth:
Language spoken at home:

Payment Method:
Basic Membership $35	Education Membership $50
Customer Email:
Card Type:	Please select...VisaMasterCard
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Expiry Date:	010203040506070809101112 20092010201120122013201420152016