Permission to Participate at www.psoriasis.org

Instructions for a Parent or Guardian

Please print out this page, sign it and fax it to:

National Psoriasis Foundation
Fax: (503) 245-0626

or mail it to :

National Psoriasis Foundation
6600 SW 92nd Ave., Suite 300
Portland, OR 97223-7195

Phone: (503) 244-7404 OR (800) 723-9166

If approval is not received in 7 days the information will be deleted.

Required Information

User Name:

Password:

Email:

Optional Information

Privacy Mode:
Selecting 'yes' hides email, ICQ number, AIM ID in profile and also hides you in 'Logged In Users' list.

ICQ Number:

AOL Instant Messenger Handle:

Yahoo Messenger Handle:

Please sign the form below and send it to us.

I have reviewed the information my child has supplied and I have read the Privacy Policy for the National Psoriasis Foundation website. I understand that the profile information may be changed by a using a password. I understand that I may ask for this registration profile be removed entirely.

Parent/Guardian Full Name:

Signature:

Relation to Child:

Telephone:

Email Address:

Date:

Please contact webmaster@psoriasis.org with any questions

Required Information
User Name:
Password:
Email:
Optional Information
Privacy Mode: Selecting 'yes' hides email, ICQ number, AIM ID in profile and also hides you in 'Logged In Users' list.
ICQ Number:
AOL Instant Messenger Handle:
Yahoo Messenger Handle:
Please sign the form below and send it to us. I have reviewed the information my child has supplied and I have read the Privacy Policy for the National Psoriasis Foundation website. I understand that the profile information may be changed by a using a password. I understand that I may ask for this registration profile be removed entirely.
Parent/Guardian Full Name:
Signature:
Relation to Child:
Telephone:
Email Address:
Date:
Please contact webmaster@psoriasis.org with any questions