Membership form 2019 - 2020 - ADHD, ASC & LD Belgium
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
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Please complete this form online if possible - or print, scan & email to
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) *
* 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?
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Please pay the required membership fee into our bank account as follows and send us a proof of payments to :   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 -
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
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