We invite you to become a member of the CHARGE Syndrome Foundation. We depend heavily on the commitment of our members to help create a better, more understanding and educated world for all individuals with CHARGE.
Please join or renew your membership today. It has never been this easy; simply click the button on the right and fill out the form. Benefits include: our quarterly newsletter, networking and scholarship opportunities, notification of research studies and most importantly, the knowledge that you have assisted individuals with CHARGE and their families. Members receive special recognition in the newsletter, website and at our office. Thank you for helping turn the goals and dreams of the Foundation into reality!
If you prefer to mail your membership, the form below may be used.
The membership levels are as follows:
- Family / Individual (1 year) - $25
- Professional (1 year) - $40
- Lifetime Silver Membership - $250
- Lifetime Gold Membership - $1000
- Lifetime Platinum Membership - $5000
- Lifetime Diamond Membership - $10000
Street Address / P.O. Box: ________________________________
City: ____________________________ State: ______ Zip: ______
Telephone/TTY: Home: ________________Work: ______________
E-Mail Address: _________________________________________
I am a Parent Relative Professional Friend Individual with CHARGE
May we give this information to other parents? Yes No
Name of Individual with CHARGE: ________________ Birthdate: _________
Please select your preferred membership level below:
New ____ Renewal ____
Family / Individual — 1 Year
Professional — 1 Year
Lifetime Silver Membership
Lifetime Gold Membership
Lifetime Platinum Membership
Lifetime Diamond Membership
Additional tax-deductible contribution: $ ___________
Total Amount Enclosed $ ______________________
Please complete and mail with membership fees/contributions to:CHARGE Syndrome Foundation Inc.
141 Middle Neck Rd.
Sands Point, NY 11050