Registration Form Below


Emergency Medical Locators (EMLA) is a nonprofit organization that conducts free biological searches for anyone who is in need of their medical history during emergency and life-threatening medical situations

Each year, thousands of adopted men, women, and children lose their precious lives to catastrophic illnesses and diseases because they are unaware of their biological medical history. These individuals live day-by-day without knowing their risks of Cancer, Diabetes, Heart Disease and a gamut of other medical conditions that are potentially    fatal but could be prevented only if they are given sufficient time, adequate information, and access to what rightfully belongs to them, their Family medical history. 

EMLA is equipped with an around the clock team of skilled Emergency Medical   Locators who find and retrieve biological sources and the pertinent medical information that is needed to save lives of the adoptee who is in need of their medical history. When    EMLA establishes contact with the biological family in question, our team of       Emergency Medical Locators communicate that the adoptee is not requesting a reunion, but rather in urgent need of their medical history. In the event the biological party would like to reunite with the adoptee, a meeting is arranged through our team of professional mediators.

**You will need to send a letter from a doctor verifying medical need.

Here are some additional medical forms you can use to assist you.

Please cut and paste and Email To emlaangels@aol.com
 

1. Registration Number (will be assigned)

 2. First Name & Last Name (current)  

     Name  

 3. Email Address

 4. Re-enter Email Address

 5. Mailing Address

     Street address

     Address (cont.)

     City

     State/Province

     Zip/Postal code

    Country

 

 6. Home Phone Number

     Home Phone

 

 7. Alternate Phone Number

 

 8. Best time to Contact if needed

 

 9. Name of Relative or Close Friend

 

 10. Their Relationship to you

 

 11. Relatives/Friends Complete Address

 

 11 a. Relatives/Friends Phone Number

 

       Selected info below will be posted in Emergency Medical Locators Registry     

 12. Adoptees Date of Birth   If unsure of date, please insert range or explain here 

 

  13. Adoptees Gender

  14. Adoptees Race

  15. Adoptees First Name at Birth

  16. Adoptees Middle Name at Birth

  17. Adoptees Last Name at Birth

  18. Adoptees City of Birth

  19. Adoptees State of Birth

  20. Adoptees County or Providence of Birth

  21. Adoptees Country of Birth

  22. Birth Mothers First Name

  23. Birth Mothers Middle Name

  24. Birth Mothers Maiden Name

  25. Birth Mothers Last Name at Birth

  26. Birth Mothers Age at time of Birth

  27. Birth Mothers City & State of Residence

  28. Birth Mothers Occupation

  29. Birth Fathers First Name

  30. Birth Fathers Middle Name

  31. Birth Fathers Last Name

  32. Birth Fathers Age at time of Birth

  33. Birth Fathers City & State of Residence

  34. Birth Fathers Occupation

  35. Birth Mothers & Birth Fathers Marital Status 

(Married, Unmarried, Divorced - Please explain)

 

  36. Hospital of Birth

  37. Doctor

  38. Name of Adoption Agency

  39. If private adoption, name of attorney or firm

  40. County Adoption took place

  41. City Adoption took place

  42. State Adoption took place

  43. Adoptees Age when Relinquished to Adoptive Parents

  44. Adoptees First Name after Adoption

  45. Middle Name after Adoption

  46. Last Name after Adoption

  47. Adoptive Mothers First & Last Name

  48. Adoptive Fathers First & Last Name

  49. Date Adoption Finalized

  50. Did Adoptee have older/younger siblings when relinquished for adoption

(Give Details -DOB or ages, sex)

 51. Amended Birth Certificate Number

 52. Original Birth Certificate Number (if known)

 53. Will photo be downloaded to afseml@yahoo.com to post in PHOTO DATABASE?

 54. Have you applied for your NON ID information from the adoption agency?

 55. Your Triad position *Note: If you are birth sibling searching for another sibling who has been adopted, please complete this registration form with THEIR information, and yourself as the searcher.

**If you are searching for more than one sibling, please complete a form for each.

 56. Have you registered with the ISRR (International Soundex Reunion Registry)? If not, download the registration form at http://www.plumsite.com/isrr/ and snail mail it.

 57. Since no one can guarantee a sucessful reunion each and every time, I hereby agree that I shall not hold Emergency Medical Locators Emergency Medical Locators nor any of its members or search  angels liable in their attempt to help me or in the outcome of my search

(I understand that if I do not provide a snail address or phone number, my search info will not be posted)

 58. Is this an urgent or emergency medical search?

 59. List Urgent Medical Conditions which would constitute an Emergency Search

 62. Additional Comments   Please  copy and paste the entire registration form into an email and send to:   emlaangels@aol.com