MAILING LIST

Thank you for signing our mailing list. By providing your name and email address we will be able to keep you informed of the development of our web site, and our new services.

Please feel free to tell us also about yourself and your needs, so that we may provide you with the information and services you need.

Any information you send us will be kept confidential and will not be shared outside of Help-Your-Self.



Gender (please choose one)

Age (choose one of 6 options)

Disability (choose one of 14 options)

Areas of need (check all that apply from the list of 11 choices):
access/modifications to your home
computer training
employment issues
equipment information
financial information
housing information
peer counseling
personal assistant search and training
prevention of injury classes
sensitivity training
transportation information

Products (check to receive information):
personal assistant training manual
SeeMeSafely lights
service animals


    

Thank You!