Friends of NCBDDD Directory

1. Directory Details

Please complete the questions to be sure that we have your most current contact information for the Friends of NCBDDD Directory. This should take no more than 5 minutes. Thank you for your time!

Question Title

I am a representative to the Friends for my organization.

First Name

Last Name

Degree(s)

Position

Organization

Email

Phone

Address 1

Address 2

City, State Zipcode

Question Title

My organization is involved in Friends, but I am not the correct contact person. Please contact:

First Name

Last Name

Degree(s)

Position

Organization

Email

Phone

Question Title

In which ways are you connected with Friends of NCBDDD? Check ALL that apply.

General Friends of NCBDDD Partner (local, state, or national)

Public Health Professional

Parent

Healthcare Professional

Early Educator

Policy Professional

Other (please specify)

Question Title

I would you like to volunteer for a Friends committee. (Check ALL that apply.)

Education and Communications Committee (plans Friends social media efforts)

Membership and Finance Committee (plans Friends open house activities at NCBDDD)

Programs Committee (plans national webinars on topics of interest for Friends)

Advocacy Coalition (plans Friends legislative education)

Question Title

You have my permission to list my contact information in the Friends of NCBDDD Directory.

Yes

No