Please print our
application by selecting the PRINT option on your
browser. Mail this completed application along with
your Membership dues to:
OPTS
P.O. Box 611
Gurnee, IL 60031
(847)782-0224
Or you
may send in $2.00 for postage and handling and we
will send you information and an application. This
$2.00 will be deducted from your first years dues,
once you become a member.
E-mail address:
Name:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
BIOGRAPHICAL INFORMATION
PLEASE INCLUDE CHILDREN, IF ANY, A DESCRIPTION OF
YOUR INFERTILITY, REASON FOR INTEREST IN SURROGACY
AND YOUR PRIOR EXPERIENCE WITH SURROGACY AND/OR
ADOPTION:
Are you currently working with an agency?
Yes
No
AREA
OF INTEREST (Check all that apply)
Traditional
(Artificial Insemination) Surrogacy
Gestational
(IVF) Surrogacy, using your own eggs and sperm
Egg
Donation
Sperm
Donation
Other
Working
with a family member
Working
with a friend
Doing
an independent arrangement on own
Using
a professional program for help in finding and
screening a surrogate
Other:
PLEASE
INDICATE THE AREAS YOU WOULD LIKE TO BE ACTIVE IN:
Help
with legislative action
Speak
out publicly or do media interviews
Write
about my experiences for OPTS NEWS
Organize
an area chapter of OPTS
Be
a "Phone Friend" that other members can contact for
information or support.
Area of experience or knowledge:
I
would like to be a media spotter for news and
articles, features, TV programs, etc. on surrogacy.
I
am interested in hosting get together for members in
my area.
Are there any areas you would like to see addressed
in the newsletter?
PHONE
FRIENDS/CYBER FRIENDS REQUEST FORM
____ I/WE WOULD LIKE THE NAMES AND NUMBERS OF SOME
PHONE FRIENDS TO TALK TO ABOUT:
____________________________________________________
____ I/WE UNDERSTAND THAT THE PHONE FRIENDS NETWORK
IS PROVIDED TO HELP US OBTAIN INFORMATION, SUPPORT
AND EXCHANGE VIEW- POINTS.
WE FURTHER UNDERSTAND THAT OPTS DOES NOT DO ANY
MATCHING OR SCREENING AND DOES NOT ASSUME ANY
RESPONSIBILITY FOR ANY ON-GOING CONTACT,
FRIENDSHIPS, VISITS OR RELATIONSHIPS THAT MAY BE
ARRANGED BY MEMBERS ON THEIR OWN.
