Membership form 2018 - 2019 - ADHD, ASC & LD Belgium
Benefits of Membership:-
* Free or reduced-price entry to all of our workshops and conferences -
* Access to Library books at Parent Support Meetings and in our office -
* Reduced-price coaching for children, adolescents, parents, and teachers -
* Free assessment of special needs of children and adolescents
ADHD, ASC & LD Belgium, Rue Washington straat 40, 1050 Brussels / Belgium
Please complete this form online if possible - or print, scan & email to
FAMILY Name and First Name - 1st person *
Your answer
FAMILY Name and First Name - 2nd partner (family memberships usually consist of 2 adults)
Your answer
Email - almost all of our info is delivered by email - if this is a problem please let us know *
Your answer
Type of Membership (August 2018 - summer 2019)
*Profession - or * Name of School or Organization (Up to 10 people from an organization or school can attend each event at the reduced member price) - or "family" - or "student / Non-employed"
Your answer
How did you hear about us?
Your answer
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 2018-19 + the name of the person / family / school or organization + 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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