ADSG takes your privacy seriously. The information here is
only for use by ADSG personnel. We do not share that information with anyone.
Your personal information will NOT be listed on this site unless you ask us to list it by
checking "yes" to publish the information in section II (listings are
limited to nickname, state, email address, and text you submit for your story).
See Section II for details. If you would like to
publish a testimonial on this site, you must complete both sections I and II. You
may view our members who wish to publish pages.
If you want your story or information about you published, enter it in Section II.
If you have already filled out the
form below and would like to change your member
information, please go to the change member form and submit your
change(s). If you would like changes to your information, please use the change form and
do not fill this form out a second time. Thank you!
(Note: * denotes
Field is required)
Section I
*First Name
*Last Name
*NickName or Name used on message forums:
*Birth Date: Month
*Day
***Year
*Email Address:
*Enter Email address again:
*Address:
Address Line 2:
*City:
*State:
*Zip:
*Country:
**Home phone:
Work phone: Fax:
*How are you connected to reactive attachment disorder or
special needs children:
*Please give a brief description of how you are connected
to RAD or special needs children.
*Please take a moment and tell us how you found this
website:
Other:
**********If you are joining as a company, please fill out the
information below: ********
