Cornelia de Lange Syndrome Foundation, Inc.
302 West Main St. #100
Avon, CT USA 06001
Phone: 860-676-8166
Phone: 800-223-8355
Fax: 860-676-8337
email: info@cdlsusa.org

CdLS Activities

TELL US ABOUT YOU

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Street Address *
City *
State *
Postal Code *
Telephone
E-mail

TELL US ABOUT YOUR EVENT

Describe Your Activity *
Date(s)	, - ,
Time	-
Location *
City *
State *

How many individuals do you expect to attend your activity?
fewer than 10 10-25 26-50 more than 50

Will you be raising funds in support of the CdLS-USA Foundation?
Yes No

Would you like to have publications to hand out during your activity?
Yes No

If Yes, which CdLS materials would you like to support your event?

the Foundation brochure
the CdLS Fact Sheet
the awareness poster
business-style awareness cards
a press release
donation envelopes
other (please, specify)

ADDITIONAL COMMENTS (500 character maximum)