PALS Membership Packet Request Form

Please enroll me as a    q New Member         q Renewing Member         q Returning Former Member

 

NAME_______________________________________________________________________________

STREET ADDRESS__________________________________________________________________

CITY_____________________________STATE/PROV___________ ZIP/POSTAL CODE________

PHONE   home:__________________________  cell:_______________________________

pager:__________________________

E-MAIL ADDRESS____________________________________________________________

 

q I am enclosing the $40 individual membership fee, or $45 institution membership fee. Please send my membership packet and add my name to the PALS mailing list.

q Please add me as a member to the PALSdoulas@ yahoogroups.com web site so that I can communicate with PALS doulas and learn about upcoming PALS events.

I have enclosed a contribution to PALS of $________

 

Signature___________________________________________________________________

Name (please print)____________________________________Date_________________

Please mail this form along with payment to:

PALS
Membership Services
2524 16th Avenue South
Room 207A
Seattle, WA 98144

Please feel free to contact PALS at 206.329.PALS or info@pals-doulas.org if you have any questions