Member Application Form

Complete the form below to register your group as a member of ECHDO. 
All fields marked with star must be completed for the form to successfully send.

Basic info
Contact person
Additional information
Privacy Policy
- I agree to hold in confidence any information shared on the ECHDO website or e-mail list that is not already in the public domain (e.g., conference presentations, published literature, Internet content, etc.) I also agree not to share any information from internal ECHDO discussions (whether in-person, on conference calls, or via e-mail) with other persons who are not ECHDO members, unless authorized to do so by ECHDO leadership or as the result of a group consensus or vote (e.g., as part of a directed group action or work plan). Finally, I will not disclose personal information that may be shared through ECHDO, such as health conditions/decisions, without express permission of the affected individual. I understand that violations of confidentiality as described herein will result in the termination of my ECHDO membership.
Optional info
Complete these fields if you would like to offer a little more information about your group.