Online DSOSN Application Company Date (Fecha) Donation Amount (Optional) $ Military? Yes No First Name (Nombre) * Last Name (Apellido) * Spouse's First Name Spouse's Last Name Address (Domicillo) * City (Ciudad) * State (Estado) * Zip (Codigo Postal) * Relationship to Person with Down Syndrome Parent Grandparent Sibling Friend Guardian Spouse Sibling(s) Name(s) and Age(s) [Nombre(s) y Edad(es) de Hermano/a(s)] Main Contact Number Spouse Contact Number Cell (Celular) Fax Email Address (Dirección de Correo Electrónico) Spouse's Email Address Are you bilingual? (Si es plurilingue?) * Yes No If yes, what language(s) and *would you be willing to assist with translations? (Idiomas que habla y si estaria dispuesto a ayudar con traducciones?) * Yes No Name(s) of Individual(s) with Down Syndrome (Individuo con Sindrome de Down - Nombre) Age (Edad) Birth Date (Fecha de Nacimiento) Services/assistance you would be willing to offer DSOSN (Servicios que estaria dispuesto a ofrecerle al DSOSN) Services and Programs you would like to see implemented at DSOSN? (Servicios y Programas que desearia ver implementados en DSOSN?) Individuals and families must be in good standing and register with the DSOSN, in order to receive benefits, and vote at the Annual meeting that is held annually in the month of April.Publicity Permit Throughout the year at various events and during programs, DSOSN take pictures/videos, and it is possible your child or family may be photographed/recorded. Please choose from the options below, you are either giving permission, or not, for DSOSN to use the photos/videos for local publicity, newspaper articles, websites, television and/or video, newsletter and brochures. I see no objection to my child/family having his/her pictures/videos, and/or name(s) used in connection with the Down Syndrome Organization of Southern Nevada I object to my child/family being photographed/video recorded. Please sign by typing in your full name. You can make your optional Donation by clicking the PayPal button below. Thank you.