Tuesday, 07 September 2010
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Registration
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Welcome to the SPECIAL LIFE community. Registering with the community provides you with valuable information like our Best Practice resource library. Registering also helps us to more effectively network the resources in your community. The information you provide is CONFIDENTIAL unless indicated otherwise as being "visible on profile".
Security Code:
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Name:
Email:
Username:
Password:
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Phone Number::
Zip Code:
Household:
An individual with a disability lives in my home
Profile of individual with disability:
Child 6 yrs old or under
Adult 21 to 49
Youth 7-12 years old
Adult 49 to 70
Teen 13-20 years old
Senior 70 or older
Nature of Disability:
Your Relationship: Check ALL that apply.:
I am a PARENT or PRIMARY CARETAKER
I WAS a primary caretaker, but not now
I am a RELATED FAMILY MEMBER (i.e.Grandparent)
I am a SIBLING of an individual with a disability
I am a FRIEND of a primary caretaker
I am a PROFESSIONAL working with disabilities
I am a STUDENT interested in disabilities
I am a volunteer that works with disabilities
I am a Church Leader or SPCL NEEDS COORDINATOR
I am an INDIVIDUAL with a disability
Other
Other Relationship:
Service Provider:
I represent a SERVICE PROVIDER organization
Organization Name:
Organization Website:
Church Affiliation:
I am currently affiliated with a church
Church Name:
Church Website:
Special Needs Ministry:
My church has a Special Needs Ministry
I would like to start a Special Needs Ministry
I would like help from Special Life Network
SPECIAL LIFE Services that I am interested in:
Community Network Meetings
Training and Education
Disability Program Start Up Support
Best Practice Resources
Special Needs Ministry Growth
Website / E-Community
Awareness Building Tools
Awareness Building Events
First Name:
Last Name:
Address:
City:
State/Province:
Country:
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Thank you for registering. After clicking the SEND REGISTRATION buttom below you will receieve an email asking you to click on an embedded link to CONFIRM your email address. Be sure to CLICK on that link. Shortly thereafter you will receive a second email indicating that your registration has been APPROVED, and you will then be able to log into the community. Thanks again for registrering and WELCOME TO SPECIAL LIFE!
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