Thanks to the many folks who have mentioned they would like to participate in some way to help the NLD cause.  NLDA, the Connecticut-based national NLD organization is dedicated to sharing information and offering support to those parents, adults and professionals interested in NLD and other neurobiological disorders.  This Adult Questionnaire will give us some idea of your interests, talents and ideas.

NLDA Adult NLD Questionnaire

 

  Name:  (Required)

  Street Address: 

  City / State / Zip:

  Business Address: 

  City / State / Zip:

  Email:

  Phone: 

  FAX: 

  Main Area of Interest:

  NLD PDD-NOD HFA AS
  Semantic-Pragmatic Hyperlexia Other

  As a participant, I would be willing to:

  Participate in a monthly adult support group in my area.

  Help facilitate a new monthly adult support group in my area.

  Chair a committee.

  Participate on a committee.

  Help organize our annual NLD Symposium.

  Participate in fund raising efforts.

  Participate in grant writing efforts.

  Act as Editor-in-Chief for our quarterly newsletter.

  Write articles for our newsletter.

  Contribute articles and/or information to www.nldline.com website

  Attend and report on conferences for our newsletter and local support groups.

  Donate materials and/or underwrite costs for NLDA projects.

  Advocate and lobby for NLD legislation.

  Complete an extensive NLD survey for research purposes.

  Give permission to network my email address with others in my state also interested in NLD.

  Comments:

  Would you like to share email with other NLD adults? Y N

I am currently enrolled in NLDA

  I would like to enroll in NLDA  and will send my enrollment fee of $50.00 (Individual) $75 (Family or Professional) to P.O. Box 220, Canton, CT 06019-0220      

  Thank you for participating in this survey.