Mailing List Form

Name

Email

1) How did you first hear of the Dyslexia Association of Singapore (DAS)?

	Newspapers / magazines / TV / radio
	Internet search
	Recommended by a relative/friend
	Referred by a doctor
	Referred by my child's teacher/school
	I'm not sure/ I can't remember
	Others (Please specify):

2) Do you know anyone who is or may be dyslexic? (tick more than one box if applicable)

	Yes, I am or at least I think I am
	Yes, a family member
	Yes, a friend/colleague
	No, I don’t know anyone who is dyslexic

3) How often do you visit our website?

4) Would you like be informed about our events and activities?

	No, thanks.
	Yes, pls. send to my email add at

Any other comments?