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First Name

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Membership Type *

See information on voting privileges below. Note: there is a maximum of one professional voting membership per organization/agency.

Personal Voting

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Please check all that apply, I am a:

Person with FASD

Caregiver of someone with FASD

Parent or family member of someone with FASD

Professional in FASD sector

Professional in a related sector (e.g. homelessness, education)

Other

(Please note that the contact information you provide is kept confidential and is not used for any other purpose.)

By submitting this form, you consent to be entered into CFAN's register of members.