RESOLVE of the Bay State - Membership Application



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Peer Discussion Groups

Topic Discussion Groups

Upcoming Programs:

Adoption Decision Making Seminar
Saturday,
May 31, 2008
9:30 a.m.- 5:00 p.m.

The Secret Club Project: Understanding Pregnancy Loss through the Arts
Tuesday,
June 3, 2008
7:00 - 9:00 p.m.

Future Programs

Membership Application

Household Membership: $55
Professional Membership: $150

(This is a printable form. Please fill in the required information, and then print and mail, or fax with your credit card information. Mail to: RESOLVE of the Bay State, 395 Totten Pond Rd., Suite 403, Waltham, MA 02451. Fax to 781-890-2249.)

Name:

Address:

City:

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Zip:

Phone:

E-mail:

Please choose membership type:

Household - $55

Professional - $150

My check is enclosed

Or charge to my:

Visa

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Exp.Date:

Signature:
______________________________

I would like the following information packets:

Adoption Information - $10

Donor Egg Information - $20

Insurance Information - $5

I would like to help further the work of RESOLVE of the Bay State by enclosing an additional tax-deductible contribution:

Contribution - $

I would like to receive information on programs and support groups emailed to me.

Yes

I am interested in information on (please select all that apply):

Primary Infertility

Secondary Infertility

Male Factor

Pregnancy Loss

Donor Egg

Adoption

Other: (please specify)

If you would like to receive weekly email updates with
program and event information, please send us an email
with the word "Subscribe" in the subject line OR type your email address
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395 Totten Pond Rd, Suite 403
Waltham, MA 02451

HelpLine: 781-890-2225
Fax: 781-890-2249
email: admin@resolveofthebaystate.org
website: www.resolveofthebaystate.org

Important Note: The information contained in this site is not intended to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in this site is intended to be a substitute for medical diagnosis or treatment.