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First Name(s)    

Last Name(s)   

Address             

City, State, Zip  

Day Time Telephone No. 

Evening Telephone No.    

Marital Status     Married     Single (Required Field)

Would you like to receive our printed information package?     Yes    No

Please each program in which you have interest:

Standard China Adoption Program       
Special Waiting Child Program (China)
Colombia Adoption Program
Guatemala Adoption Program


How did you hear about our web site? 

If "other" please specify in the text box below or if you can provide more details about how you learned about our web site we would appreciate it.

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May we include you on our e-mail list to periodically receive news and adoption information?   Yes    No

Please include any comments or questions below.   (If you have a question, please be sure to provide your email address above.)

How did you like our web site?  What was the most helpful to you?  What would you like to see that was not already included?

If you have asked a question and would like a response via e-mail, please be sure you have included your e-mail address above.  If you have requested our printed information package, please be sure that you have included your mailing address above.  Thank you.