Registration Form

Registration Form
For Arab Handicapped Societies & Centers
Exceptional Arab Family

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How to use this Form:

		To reduce "Banner", click on its "UPPER" right arrow.
		Type in the Form, on screen response, (fill out applicable blanks).
		Press "TAB" to move between blank spaces. When finished, please print the Form.

Arab Handicapped Societies & Centers, needed support: .

Information & Education Support For Arab Children Services/Prorams:
Please check (X) boxes where support is needed. If a topic is not listed, attach a sheet of paper with typed information.

	Arab children with Down Syndrome		Arab Autistic children
	Arab children with cystic fibrosis		Deaf Arab children
	Blind Arab children		Other Information

Needed Equipment & Supplies:
Please attach a sheet of paper with specific typed description for needed equipment and supplies. Try to obtain the price,
model number ... etc. for needed equipment and supplies. Received information will be entered in our database to
help your society or center to receive needed items. All our services are offered FREE OF CHARGE to Arab handicapped
societies and centers.

Suggestions: Suggestions to improve our services are welcome. You may attach additional typed sheets if necessary.
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Volunteers:
Briefly describe your skills below. You may attach a typed resume. Also, you may be located any where in
Arab countries, Asia, North America, Australia and Europe. Knowledge of Arabic language is not required but helpful.

REGISTRATION INFORMATION: (Please complete only applicable information)

President Name
Contact Name	Title
Arab Society or Center
Date Established	Total Number of Residents
Residents Sex	Male . Female . Both
Residents Age	Adults . Children . Both
Address
City
State	Zip Code . Country
Area Code	Telephone number . FAX number
E - Mail Address
Web Site Address

Please Print Completed Form And Mail It To:
Consultants Institute
P.O. Box 748
Lake Forest, California 92630-0748, USA
(949) 472-3767

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