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Alert Me Band Request

Thank you for supporting New Directions. While we have you here, let's confirm we've got the best contact information for you.

Contact Information
*

First Name
Last Name
*

*

*

Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country


Connection to Down Syndrome
*
What's your connection to Down Syndrome? Which option best describes your relationship to an individual or people living with Down Syndrome?
Tell us about your individual with Down Syndrome!
What's their name, birthday, gender, favorite Disney character, etc?

First Name
Last Name

Month / Date / Year

Message or Note

Are there any immediate questions, concerns, or needs you'd like us to provide assistance with?

Thank you

Your submission will send an email to the board of directors, who will reply with a unique coupon code to be used to checkout with your Alert Me Band on their website. Allow us 1-2 days to reply via email.