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 Parent Questionnaire will give us some idea of your interests, talents and ideas. Please be aware that while the webmistress of NLDline is a board member of NLDA, the website NLDline is a separate entity and is NOT connected with the website of NLDA.

NLDA Parent Questionnaire

   Name:  (Required)

  Street Address: 

  City / State / Zip:

  Email:

  Phone: 

  FAX: 

  Main Area of Interest:

  As a participant, I would be willing to:

  Participate in a monthly parent support group in my area.

  Help facilitate a new monthly 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.

  Keep the NLD database updated.

  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 parents in your state? Y N

  I am currently enrolled NLDA.

  I would like to enroll in NLDA  and will send my enrollment fee of $50.00 (Individual) $75 (Family or Professional) to 2446 Albany Ave. W. Hartford, CT 06117

  Thank you for participating in this survey.