Membership form 2019 - 2020 - ADHD, ASC & LD Belgium

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Benefits of Membership:-
* Reduced-price entry to all of our workshops and conferences -
* Access to Library books -
* Advice for children, adolescents & adults with Neurodiverse conditions
* Workshops for schools or other organisations, if requested

Please complete this form online if possible - or print, scan & email to info@adhd-edu.be

FAMILY Name and First Name - 1st Family member / or Name of Professional or Student or non-employed person / or Name SCHOOL or ORGANISATION /

FAMILY Name and First Name - 2nd partner (family memberships usually consist of 2 adults)

Email - almost all of our info is delivered by email - if this is a problem please let us know - Your email will be added to our mailing list - but it is possible to unsubscribe whenever you wish *

Type of Membership (Sept 2019 - August 2020) *

Family (both partners mentioned above) : 50 €

School / Organization * : 150 €

ADHD, ASC & LD Professional (a Professional eg psychiatrist or therapist) : 70 €

Full-time Student / Non-waged person : 20 €

* Name of School or Organization (Up to 10 people from an organization or school can attend each event at the reduced member price)

How did you hear about us?

I was a member before

From a school (eg via a teacher of the school office)

From a friend or acquaintance (including from another parent you met at school / elsewhere)

Facebook

Twitter

Email from us (eg an events email or an individual email)

Clear selection

Please pay the required membership fee into our bank account as follows and send us a proof of payments to info@adhd-edu.be : 001-5695038-50 or IBAN: BE86 0015 6950 3850 // BIC: GEBABEBB // Membership 2019-2020 + the name of the family / or school or organization / or professional / or student or non-employed person / + type of Membership

If you have a problem with - or questions about - this form, please email us - info@adhd-edu.be

We are in full compliance with the new Data Protection Laws that went into effect on 25 May, 2018. We therefore will not share your personal information with third parties. Please read our GDPR policy here https://buff.ly/2u2H34J

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms