© ameriface, PO Box 751112, Las Vegas, NV 89136-1112
Toll-free: (888) 486-1209 Fax: (702) 341-5351 info@ameriface.org
Name:
Address:
City:
State:
Zip:
E-Mail:
Phone:
I am a:
By clicking the "FREE MEMBERSHIP" button, I confirm that I am submitting my electronic signature on this form to become a MEMBER of AmeriFace and its family of programs. I also agree to receive future correspondence from AmeriFace and any or all of its related programs per the preferences I have outlined above. I agree to all Terms & Conditions as outlined on the AmeriFace website, and any related websites, forums, groups and pages.
Condition:
Age of Patient:
How did you hear about AmeriFace and/or one of its specific programs?
Do you require assistance/referral?
I am also interested in:
July is National Cleft & Craniofacial Awareness
& Prevention Month (NCCAPM)!
Cleft and craniofacial conditions affect thousands of infants, children, teens and adults in the United States each year. Some are born with congenital anomalies like cleft lip and palate, others with more complex, life-threatening craniofacial conditions. Some are burned; others are injured in accidents and animal attacks, or diagnosed with various oral/head/neck and skin diseases. Learn more...
Register
* July is National Cleft & Craniofacial Awareness & Prevention Month (NCCAPM)! All interested organizations and entities, as well as supportive individuals, may associate themselves with National Cleft & Craniofacial Awareness & Prevention Month (NCCAPM). Awareness tools may be used at will; however, use in conjunction with causes not in line with NCCAPM values or its Code of Ethics and/or by entities operating in an unlawful or distasteful manner, will be deemed unauthorized and all rights are hereby revoked immediately. All necessary and appropriate action will be taken, including legal action, if necessary, at the cost of the offending party. By downloading and/or displaying these materials, you agree you will not alter these materials in any manner and will not use them for fundraising activities not directly associated with or approved by NCCAPM. You agree to the Terms & Conditions outlined on the NCCAPM website and all other terms as outlined by AmeriFace and its family of programs. Organizations, associations and business interested in sponsoring or advertising in support of National Cleft & Craniofacial Awareness & Prevention Month, contact us at info@nccapm.org.
Get involved! Tell us about yourself!
the
cleft/craniofacial
advocates
Making a world of difference in a world of facial differences...
®
®
