One moment please...
DSA Mom's Ornament Exchange/Intercambio de ornamentos
Name/Nombre y Apellido
*
First Name
Last Name
Email/correo eléctronico
*
Verify Email
*
Phone/telefono
Address/ dirección
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Individual with Down syndrome/ Persona con síndrome de Down
*
First Name
Last Name
Birthday of Individual with Down Syndrome/Fecha de Nacimiento de la persona con síndrome de Down
*
(mm/dd/yyyy)
Household Income/Ingreso familiar
*
This information is collected for grant writing purposes.
select one
$1 to $24 999
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000 and greater
Prefer not to answer
Ethnicity of Individual with Down syndrome/ Etnia de la persona con síndrome de Down
*
This information is helpful for grant applications. Please check all that apply./Esta información es útil para propósitos de ayuda financiera
American Indian or Alaska Native/ Indio americano o nativo de Alaska
Asian/ Asiático
Black or African American/ Negro Afroamericano
Hispanic or Latino/ Hispano o Latino
Native Hawaiian or Other Pacific Islander/ Nativo hawaiano u otro isleño del Pacífico
White/ Blanco
Prefer Not To Answer/ Prefiero no responder