Family Name:
His Name:	DOB:
Her Name:	DOB:
Email Address:
Street Address:
City, State, Zip:
Home Phone:
His Work:	Her Work:

Date/Place of Current Marriage:
Any Previous Marriages?
Number of Birth Children:	Ages:
Number of Adopted Children:	Ages:

Do you have a current homestudy or one in progress?      Yes    No

If yes, agency's name and address:

Age range of Child desired:
Gender:      Boy      Girl      Undecided

Please send me information sheets on the following programs:
Mexico Russia China	Columbia Guatemala Bulgaria	India Romania Viet Nam	Philippines Thailand Hong Kong	El Salvador
Homestudy Only Identified Birthmother		U.S.Waiting Children (California families only) AUI Birthparent Center Program

Comments and Questions:

By submitting this pre-registration via the internet, you agree to be bound to the above pre-registration and all statements made herein.