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The National CMV Foundation is currently collecting information to connect parents for personal advocacy and community support efforts. We would love to add your family’s information to the database. If you are interested in being apart of our efforts please respond with the following information:

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* 1. Last Name:

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* 2. Parent/Guardian First Name(s):

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* 3. Address: (Please include street address, city, state, and zip code)

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* 4. Email Address:

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* 5. Phone Number:

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* 6. I HAVE READ AND AGREE TO THE FOLLOWING;


I acknowledge that the National CMV Foundation, Inc. is collecting information to connect parents for personal advocacy and community support efforts and is not providing advice or legislative consulting services to any individuals, nor is the National CMV Foundation, Inc. endorsing any particular bill or political candidate(s).

I hereby grant the National CMV Foundation, Inc. permission to use my name and contact information for its CMV Parents Database.

I understand that my participation in this program is voluntary. It is up to me to decide whether or not to take part in this program. I am free to withdraw at any time and without giving a reason. Withdrawing from this program will not affect the relationship I have with the National CMV Foundation, Inc.

I ACCEPT THE TERMS AS PROVIDED BY THE NATIONAL CMV FOUNDATION.

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