I am a Registered Voter.

YOUR PHONE NUMBER (Area Code, Prefix, Suffix)

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ARE YOU A MEMBER OF THE ADOPTION TRIAD?

(CHECK ANY BOXES BELOW THAT APPLY)

I AM AN ADOPTEE

I AM A BIRTH PARENTS

I AM AN ADOPTIVE PARENT

I AM A SIBLING OR OTHER RELATIVE OF AN ADOPTEE

I AM A SIBLING OR OTHER RELATIVE OF A BIRTH PARENT

I AM A SIBLING OR OTHER RELATIVE OF AN ADOPTIVE PARENT

I AM NOT RELATED TO ANY TRIAD MEMBERS AND AM NOT A TRIAD MEMBER MYSELF

HAVE YOU BEEN RE UNITED WITH A MEMBER OF YOUR BIRTH FAMILY? YES NO

HAVE YOU BEEN REJECTED BY A MEMBER OF YOUR BIRTH FAMILY? YES NO

WHAT IS YOUR OCCUPATION?

WHO IS YOUR EMPLOYER?

HAVE YOU EVER EARNED ANY MONEY FROM ANY ACTIVITY WHICH RELATED TO ADOPTEES

OR BIRTH PARENTS SEARCHING FOR EACH OTHER? YES NO

DO YOU HAVE GOOD WRITTEN COMMUNICATION SKILLS? YES NO

DO YOU HAVE ANY PUBLIC RELATIONS EXPERIENCE? IF SO PLEASE GIVE DETAILS.

DO YOU HAVE ANY LEGAL EXPERIENCE? IF YES PLEASE GIVE DETAILS

ARE YOU WILLING TO PRINT, ASSEMBLE, AND MAIL OUT ABORN EDUCATIONAL PACKAGES?

PRINT ASSEMBLE MAIL

DO YOU HAVE A WEB PAGE WHICH DEALS WITH ADOPTION?

YES HERE IS THE URL TO MY WEB PAGE

PLEASE LIST ALL ADOPTION RELATED ORGANIZATION TO WHICH YOU BELONG.