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*First Name *Last Name *Address 1 Address 2 *City *State -- Select -- Armed Forces Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Col Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska Nevada New Hampshire New Jersey New Mexico New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming *Zip *Phone Organization *Email

*How did you hear about ADF? Please select... ADF Event Church Friend Internet Legal Ally Mail Ministry Friend (Donor) Newspaper/Magazine Radio TV Other  *specify:

*Key Issue  Please select... Religious Freedom Sanctity of Human Life Traditional Family Values

*Are you presently represented by legal counsel in regard to this issue?  Please select... Yes No

*Please provide a brief overview of the facts relevant to your inquiry.

Please note that we are unable to represent individual persons in divorce actions, child custody disputes, or other matters outside of our primary areas of interest, and are unable to provide referrals for general legal action. In addition, please contact the legal team only If you are directly involved in a situation that pertains to one of our key issues: religious freedom, sanctity of human life, or traditional family values. I agree: By contacting the Alliance Defense Fund and notifying ADF about this matter, I have not entered into an attorney client relationship with the Alliance Defense Fund, the Alliance Defense Fund does not represent me, and no representations have been made to me indicating that the Alliance Defense Fund will undertake legal representation of any party relating to the information provided. Further, any information provided by me will be used for evaluative purposes and may be shared with the staff of the Alliance Defense Fund as well as with allies of the Alliance Defense Fund for the purposes of evaluating a potential legal claim.

Contact by Telephone or Fax: Telephone: 1-800-TELL-ADF Fax: 1-480-444-0027