702-648-1990

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MEMBER REGISTRATION

Please complete and submit the membership form and waivers below.

If you have more than one child or family member with Down syndrome, please complete separate applications for them. For any non-applicable sections, please put N/A.

If you would like to complete and submit a physical application and forms, please download the application here. Completed application and forms can be mailed to the DSOSN office at 5300 Vegas Dr. Las Vegas, NV 89108 or can be emailed to us at dsosn@dsosn.org.

Application Type

New Membership

Membership Renewal

Changes for Directory

Membership Type

Single Membership

Family Membership

Community Supporter

Application Date

Your Information

First Name

Last Name

Home Phone

Cell Phone

Address

City

State

Zip Code

Are you of Hispanic or Latino descent? (Cuban, Mexican, Puerto Rican, South or Central America, or other Spanish culture)

Yes

Language(s) you speak

I am a(n)....

Parent of a child with Down syndrome

Parent of a child with Down syndrome who has passed away

Family member to someone with Down syndrome

Family member to someone with Down syndrome who has passed away

Individual with Down syndrome

Caregiver to someone with Down syndrome

Guardian to someone with Down syndrome

Member of the community who doesn't have/care for an individual with Down syndrome

Individual with Down syndrome's Information

First Name of Individual with Down syndrome

Last Name of Individual with Down syndrome

Date of Birth of Individual with Down syndrome

Are they of Hispanic or Latino descent?

Yes

Language(s) they speak

Age

Relationship to You

Family Member(s) Information

First & Last Name of Family Member

Relationship to Individual with Down Syndrome

First & Last Name of Family Member

Relationship to Individual with Down Syndrome

Forms & Waivers

Please download, complete, and upload the following forms and waivers before submitting your membership application. If you have trouble uploading them, you can email them to us at dsosn@dsosn.org.

Emergency Contact Form

Hold Harmless Agreement

Media Waiver

Please upload each form separately in the format:

Last Name, First Name_Name of Form

as supported .doc(x) or .pdf files (Max 15MB).

Emergency Contact Form

Upload File

Upload supported file (Max 15MB)

Hold Harmless Agreement

Upload File

Upload supported file (Max 15MB)

Media Waiver

Upload File

Upload supported file (Max 15MB)

Preferences & Acknowledgments

I am interested in hearing about volunteer opportunities.

I am interested in helping out at events.

I am bilingual and am interested in assisting with translations.

If yes, please list which language(s) you would be willing to assist with:

I authorize the verification that the information provided on this form is correct.

By completing this Membership Application, you consent to Down Syndrome Organization of Southern Nevada including your name and details in their Membership List and email list for membership, administration and support purposes.

Thank you for submitting your membership application! As a member, you will receive emails regarding our programs, services, and events. Please let us know if you have any questions at (702) 648-1990 ordsosn@dsosn.org.

Down Syndrome Organization of Southern Nevada (DSOSN) is a 501(c)(3) nonprofit organization serving individuals and families in Southern Nevada affected by Trisomy-21, more commonly known as Down syndrome. Nonprofit Federal Tax ID: 94-3040560.

dsosn@dsosn.org

702-648-1990

702-648-2020

5300 Vegas Drive Las Vegas, NV 89108

Monday - Friday: 8 a.m. - 4 p.m.

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