Chinese Parents Association for the Disabled 華裔殘障者家長協會洛杉磯總會
Member Registration 會員登記表
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Email *
Are you registering for yourself or as a parent? 您為自己還是作爲家長來登記? *
Please enter your child's information. 如果是家長請輸入您孩子的信息。
Please use your address and contact information if your child's contact information is same as yours.
如果你的孩子沒有獨立的地址和聯繫方式,請留家長的地址和聯繫方式。
Child's English Name 子女英文姓名 *
Child's Chinese Name 子女中文姓名
Sex 性別 *
Date of Birth 出生日期 *
MM
/
DD
/
YYYY
Regional Center 區域中心
Diagnosis 診斷 *
Address 地址 *
Telephone 電話號碼 *
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