GLOBAL DC Fly-In Registration

First Name *

Last Name *

Nickname

Your Birth Date *

Pronouns

Gender * Gender

Ethnicity

American Indian or Alaskan Native

Caucasian/White

Asian or Pacific Islander

Black or African American

Hispanic or Latino

Prefer to self-describePrefer to self-describe

Prefer not to say

Email

Cell Phone Number *

Address *

Address

Address Line 1

Address Line 2

City

State/Province

Zip/Postal

Country

What is your connection to Down syndrome? (Check all that apply)

Individual with Down syndrome

Parent of an individual with Down syndrome

Sibling of an individual with Down syndrome

Other Relative of an individual with Down syndrome

Caregiver of an individual with Down syndrome

Medical professional

Employee of a Down syndrome organization

Other (please specify)Other (please specify)

Have you participated in a GLOBAL DC Fly-In before?

Yes

No

Other government advocacy experience:

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