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If your organization deals with topics related to psychological trauma, PTSD, childhood abuse,
or dissociative experiences Sidran Institute would like to list it in our resource database. To be included in the
Organization Directory, please complete and submit the questionnaire below. There is no charge for inclusion.
If you do not have a forms-capable browser, please e-mail us at tracy.howard@sidran.org or print out a PDF version, fill it out, and fax it to us at 410-560-0134. Otherwise, please fill out the form online and submit it to us.
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| (*) = required field |
| Organization |
| * Organization Name: |
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| * Contact person: |
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| Title: |
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| * Street address: |
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| * City : |
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| * State/Province : |
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| * Zip/Postal Code : |
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| * Country : |
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| * E-mail address : |
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| * Phone : |
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| * Fax : |
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| Type of Organization |
| * Please describe the nature or focus of your organization (professional, survivor support, family support, information, political, etc.) : |
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| * Is this a membership organization? : |
Yes
No
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| * Please list preferred keywords for searching : |
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| Membership Criteria |
| * Please list any requirements for membership or participation in program activities : |
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| Membership Benefits |
| * Please list and describe any membership benefits (such as subscriptions to publications, discounts on products, attendance at conferences, etc.) : |
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| Purpose |
| * Describe briefly the main purpose of your organization : |
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| Services and Activities |
| * Please list and describe the services and program activities your organization offers : |
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| If a membership organization, are any of the above available to non-members? : |
Yes
No
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| If yes, please describe : |
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| Geographic Scope |
| Is the organization : |
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| Local? : |
Yes
No
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| If Yes, please give the geographical area: |
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| National? : |
Yes
No
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| If Yes, what country? : |
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| International? : |
Yes
No
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| If Yes, what is the scope? : |
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| If your organization has one or more publications, please click here to provide us with information. |
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