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Free Custody Clinic Registration
  1. Participant’s Information
    Your Name:
    Address:
    City:
    State:
    Zip:
    Home Phone:
    Work Phone:
    E-mail:

  2. Select Clinic Dates and Time:
    Saturday, December 5 and 19 10 a.m.–12 p.m.

  3. How do you prefer that we contact you?
    E-mail:
    Home phone:
    Work phone:
    Regular mail:

  4. Have your child(ren) lived in D.C. for at least the last six months continously before today?
    Yes      No


  5. Are you represented by an attorney in your custody matter?
    Yes      No

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AIDS Walk October 3, 2009
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