We will respond to your request as quickly as possible!

Your name:
Your Phone Number:
Email address:
PLEASE double check that your email address is correct! Thanks!

YOUR Registraton #(If you have registered with us.)

The Registration # you are inquiring about?

Please tell us a little bit about the person you are searching for and please supply some identifying information that will help us to either rule out or confirm a match.
YOU are searching for:	Adoptee Birth Parent Member of Adoptive Family Member of Birth Family Friend, Searcher
Gender of person you are searching for?	Male Female
Birthdate of person you are searching for:
City/State of Birth:

Now, we need any IDENTIFYING INFORMATION that will help to confirm a match.

(This information will be kept strictly confidential and will not be shared with ANYONE - it is for the use of this Registry ONLY and will ONLY be used to confirm a match)

 If you would like to have us forward a message directly to this Registrant from YOU, Please type it in the box provided below.

(IF you would like us to include YOUR PERSONAL E-MAIL ADDRESS with this message, please provide it in this box - otherwise it will not be included with the message. )

Thank you! Your request will be handled as quickly as possible!

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