2022 NLDSS Membership

Newfoundland & Labrador Down Syndrome Society: 2022 Membership Application

To renew your membership or to become a new member with the Newfoundland and Labrador Down Syndrome Society please complete the form below. If you have any further questions or concerns you can contact our office at 738-3336 or send an email to nldss@nl.rogers.com.
Type of Membership *

Family Membership Friend of NLDSS

Family Membership

Please complete the following section if you selected 'Family Membership' membership type.
Name of Individual with Down syndrome

First Name Last Name
Date of Birth (Individual with Down syndrome)

Month Day Year
Date
Name (Parent/Guardian)

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
Phone Number

Area Code Phone Number
Name (Parent/Guardian)

First Name Last Name
Address (if different than above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
example@example.com
Phone Number

Area Code Phone Number
Additional Family Members
Daycare/School/Work of the Individual with Down syndrome
Will be used to identify daycares/schools/organizations that may wish to have educational materials available, presentations for staff/students regarding Down Syndrome and to participate in World Down Syndrome Day.
Do you want to receive communication/ updates from NLDSS?

Yes No
Photo Release

Please complete the following section if you would like to provide permission for you and/or your child to be photographed by NLDSS.
I, First Name Last Name give permission to the Newfoundland and Labrador Down Syndrome Society to take pictures of myself and/or my dependent child for promotional use of the organization.
Signature
Date

Month Day Year
Date

Friend of NLDSS

Please complete the following section if you selected 'Friend of NLDSS' membership type.
Name

First Name Last Name
How do you identify?

Friend of a person with Down syndrome Family of a person with Down syndrome Educator of a student with Down syndrome Health Care Professional Business/Organization
Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail
example@example.com
Phone Number

Area Code Phone Number
Name of Individual with Down syndrome (if applicable)

First Name Last Name
Do you want to receive communication/updates from NLDSS?

Yes No
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Newfoundland & Labrador Down Syndrome Society: 2022 Membership Application