2009 CHARGE Conference:

Get information on the CHARGE Conference 2009 Join us for the 2009 conference at the Indian Lakes Resort in Chicago, Illinois.

Get info about our past conferences.


CHARGE Syndrome Foundation Video

CHARGE Foundation Video View a video about the foundation.


Membership

We invite you to become a member of the CHARGE Syndrome Foundation. With your membership, you'll receive our quarterly newsletter, CHARGE Accounts, stay abreast of latest news and events, and support the foundation's research goals. 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 ____

Individual/Family — 1 Year
Individual/Family — Lifetime Silver Membership
Individual/Family — Lifetime Gold Membership
Professional
Organization
Additional tax-deductible contribution: $ ___________
Total Amont 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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