Let's Talk Dads - Southwest Human Development

What is your name?

First Last

What is the best phone number to reach you?

What is your email address?

Are you an Arizona resident?

Have you participated in Let's Talk Dads before?

What is your co-parent's/partner's name? (If applicable)

First Last

What is your co-parent's/partner's email address? (If applicable)

What is the first name and date of birth of your child(ren)?

Preferred Child T-Shirt Size

Preferred Father T-Shirt Size

Preferred Shipping Address for Let's Talk Dads Materials

Mailing Address City State ZIP Code

Let’s Talk Dads