Printable Advocacy Information Form

Advocacy Information Form

Dear HDSA Advocate,

We are requesting mailing information from our Advocates to enable HDSA to send materials that may not be appropriate to send via email (i.e. large files that could be placed on a CD rom, audio PSA CD’s etc). Providing this information is completely voluntary, information will remain confidential and will be used internally only. It will not be used for any purpose other than advocacy. HDSA would appreciate hearing from anyone who does not wish to share their information. Please complete this form with your mailing address.

It is important that you keep us updated on any changes to your email and mailing addresses as quickly as possible. If you have spam filters on your email system, please adjust them so you can receive email alerts and advocacy on line via the hdsainfo email address (hdsainfo@hdsa.org). If you have any questions, please contact Advocacy and Family Services Coordinator Annie Sukhnandan at sukhnandan@hdsa.org.

Please check one of the following:

I want to receive HDSA information via mail and email.
I do not want to receive HDSA information via mail.

Please complete the following contact information below:

Name: _____________________________ Evening Phone: _____________________

Address: ___________________________ Email Address: _____________________

City: ______________________________ State: ________ Zip Code: ___________

Thank you for your support of HDSA and for adding your voice to our advocacy network.

Sincerely,

Annie Sukhnandan
Advocate and Family Services Coordinator

Please fax completed form to
Annie Sukhnandan at 212-239-3430