NLDline 

Thanks to the many folks who have mentioned that 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 Professional Questionnaire will give us some idea of your interests, talents and ideas.

NLDA Professional Questionnaire

  Name:  (Required)

  Street Address: 

  City / State / Zip:

  Business Address: 

  City / State / Zip:

  Email:

  Phone: 

  FAX: 

  Professional area:

  Educational Professional  Medical Professional   Other   

  Main area of interest:

  NLD PDD-NOD HFA AS
  Semantic-Pragmatic Hyperlexia Other

  As a professional working in these areas, would you:

  Be interested in being included on the NLDline website database for professionals working with NLD clients.

  Be willing to speak on NLD or a related subject () at local mini-workshops     and/or at NDLA's annual NLD symposium .

  Be interested in contributing articles and/or information to www.nldline.com website.

  Be willing to lend your expertise to NLD parents and/or NLD support groups..

  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 professionals in your state? 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.