Aware-RSD Application To Join Aware-RSD
First Name & Last Name:
MSN/Hotmail/Net Passport Nickname:
Full Mailing Address:
Home & Cell #’s:
All e-mail addresses:
Any Teen(s) between 13-16?
How did you acquire your condition?
Length of time you have been afflicted:
Body Parts Affected:
List any interests/hobbies:
List online Support Groups:
List face to face Support Groups:
"I, ___________________ ,
that if any information is found to be untrue I will be denied as a member and if given membership I maybe removed of all
membership capabilities ASAP.
Your Name: ________________________
Full Name: _________________________