Latin America Parents Association
2003-2004 Membership/Renewal Form

LAPA membership dues are $25 per year.  Memberships are for a year starting June 1 and ending May 30.  New memberships sent in after April 15 will extend through the next membership year.  Please send your check payable to LAPA-NCR and this form to LAPA-NCR, P.O. Box 4403, Silver Spring, MD 20914-4403.

Membership Dues

$25.00

  
Tax Deductible Contribution

Check number   

Total Payment

Today's Date (mm/dd/yyyy)

Membership Information

New member Are Adopting or Planning to Adopt a Latin American child (Hopeful) Single
Renewal Have Adopted a Latin American child (Full Member) Not Single
  All others (Associate Member)  
Name
First Middle Last

Work Phone

Spouse's First Spouse's Middle Spouse's Last Spouse's Work
Address
Street

City State
 
Zipcode Country
Home Phone E-mail address

Children

 

Full

Name        

Sex

Child 1 First Middle Last MF
Child 2 First Middle Last MF
Child 3 First Middle Last MF

Birthday
(mm/dd/yyyy)		 Country of Adoption or Biological Child Source or Agency Arrival Date
(mm/dd/yyyy)
Child 1
Child 2
Child 3

Support Network

An important LAPA function is our support network.  May we give your name and phone number to those with questions about your source and country, adopting the same age child, etc.?

Yes  No     Time to Call 

If you are in the process of adopting, LAPA provides information and support through the LAPA line, 301-431-3407.  We would like to know how you are doing and help with this process.

Comments/Suggestions (about your situation, about LAPA, etc.)

Directory Release

To enable current LAPA members to share experience, support and information, LAPA provides a directory that is updated annually. The directory is copyrighted and may not be resold or used in any way for fund-raising or for commercial purposes. Directory information includes names of family members, address, home phone number, birthdays of all children and source country of adopted children.

Include us in the LAPA membership directory.  Do not include us in the directory.