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Join the CARES Community

Free membership!
Your complete mailing address is needed so that we can send you a new - member packet and news about our upcoming events. All information collected through this form will be kept strictly confidential.

 
Name:  
Address:  
City:  
State:  
Postal Code:  
Province:  
Country:  
Email:  
Re-enter Email:  
Telephone:    

Home:

  
Work:
  
Cell:
  

Would you share something about yourself with us? This information is for our own records so that we can better meet your needs. All personal information will be kept strictly confidential.

 
I am registering because:

I am a of a child (or children) with CAH.

Please provide the following information about the affected child or children:

Child's Name: Birth Yr Gender: CAH Type:
Male Female
Male Female
Male Female
 
I am an adult with CAH

Please provide the following information about the affected adult:

Name: Birth Yr Gender: CAH Type:
Male Female
Male Female
Male Female
       
I am a healthcare professional interested in learning more about CAH.
Specialty:
Hospital/University/Department:
 
 
   
Are there any topics that you would like to see covered in our upcoming newsletter or conferences?  
 
   
Would you be interested in contributing an article to the CARES Foundation newsletter? yes no  
What topic?  
 
   
Are you interested in volunteering? (Check all that apply)  
Skills as a graphic designer for CARES Foundation materials.  
Help at the CARES Foundation office (Northern NJ).  
Help at a CARES Foundation sponsored event.  
Start a support group in my area.  
Help recruit financial sponsors.  
Work on a fundraising project.  
Type of fundraising project:  
   
 
I learned about CARES from:  
Name: (optional)  
Hospital:  
My state's Department of Health.  
The internet.  
A friend or family member.  
Other:  
   
Preferences:
  As outlined in our privacy policy, CARES Foundation will not release your contact information to anyone without your permission to do so. Please check the box below if you would like to be contacted by a Support Group Leader in your area. Support Group Leaders are trained volunteers whose families are affected personally by CAH. They organize local speakers and events and can help answer some of your CAH questions.
 
Yes, I would like to be contacted by a Support Group Leader in my area.
 
Please sign me up to receive news and announcements from CARES Foundation, Inc.
   
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