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CHARGE Research

Clinical Database Project

 

How To Give

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Make a tax-deductible contribution to the CHARGE Syndrome Foundation using a major credit card.

If you prefer to mail your contribution, use this form.

 

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Membership

Membership Button - this will take you to the new online membership form

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:

 

Name: _______________________________________________

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

box 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

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