Get Involved

Be a part of NEOFAN and the support and resources it offers. To receive NEOFAN emails regarding upcoming programs and events, research findings, legislation, and more, please complete the form below. It is only necessary to submit one parent’s name and an email address, the remainder of the form is optional. The other data will be utilized to help plan activities and events. For any questions, please email info@neofan.org or contact us.

Parent First Name (required)

Parent Last Name (required)

Parent First Name

Parent Last Name

Your Email (required)

Address

Phone


Name (Child 1)

DOB (Child 1)

School (Child 1)

Allergy (Child 1)

 None Peanut Tree Nut Dairy Egg Wheat Soy Shellfish Fish Other (please describe below)


Name (Child 2)

DOB (Child 2)

School (Child 2)

Allergy (Child 2)

 None Peanut Tree Nut Dairy Egg Wheat Soy Shellfish Fish Other (please describe below)


Name (Child 3)

DOB (Child 3)

School (Child 3)

Allergy (Child 3)

 None Peanut Tree Nut Dairy Egg Wheat Soy Shellfish Fish Other (please describe below)


Name (Child 4)

DOB (Child 4)

School (Child 4)

Allergy (Child 4)

 None Peanut Tree Nut Dairy Egg Wheat Soy Shellfish Fish Other (please describe below)


How did you hear about NEOFAN?

Are you interested in receiving emails from NEOFAN about upcoming events?
 Yes No

Interest and Level of Participation

 Attending Events/Programs Volunteering on Occasion Volunteering Regularly Leadership Role

In what areas would you like to see NEOFAN engage?

Disclaimers: At NEOFAN, we respect your right to privacy and we understand that all who submit personal information be in control of such information. "Personal information" includes, but is not limited to, name, address, telephone number, e-mail address, schools and children’s ages. NEOFAN does not sell, rent, swap or otherwise disclose any of this information to third parties. NEOFAN adopted this policy to inform users that any personal information provided is collected and stored and may be used in the future solely by NEOFAN including but not limited to the marketing of events and/or programming. NEOFAN reserves the right to use any photograph/video taken at any event sponsored by NEOFAN, without the expressed written permission of those included within the photograph/video. NEOFAN may use the photograph/video on their Facebook page, website or in other publications used or contracted by NEOFAN including but not limited to: brochures, invitations, books, newspapers, magazines, television, websites, etc. To ensure the privacy of individuals and children, images will not be identified using full names or personal identifying information without written approval from the photographed subject, parent or legal guardian. A person attending a NEOFAN event who does not wish to have their image recorded should make their wishes known to the photographer, and/or the event organizers, and/or contact NEOFAN at info@neofan.org, in writing of his/her intentions and include a photograph. By participating in a NEOFAN event or by failing to notify NEOFAN, in writing, your desire to not have your photograph used by NEOFAN, you are agreeing to release, defend, hold harmless and indemnify NEOFAN from any and all claims involving the use of your picture or likeness. Any person or organization not affiliated with NEOFAN may not use, copy, alter or modify NEOFAN photographs, graphics, videography or other, similar reproductions or recordings without the advance written permission of an authorized designee from NEOFAN. Thank you for your understanding and cooperation. NEOFAN is not a medical organization and is not engaged in rendering medical advice or recommendations. The website, discussions, meeting minutes, handouts, speakers, and all other products of our group do not constitute medical or legal advice and should not be relied upon as such. Please discuss individual health questions and medical issues with a qualified personal physician.

I have read and agree to the terms and conditions outlined within the disclaimer

 I Agree

Signature (type name)


Date Signed