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Infertility and Adoption Support (IAS) Membership Application

Infertility & Adoption Support, Inc(IAS) is a non-profit organization and depends on the contributions of our members.
Please become a member of IAS today and help us help our community deal with these emotional and life
changing issues. Thank You!

Our members enjoy the access to post on our forum, full access to our library of resources, members only events and
functions, and discounts to IAS seminars and conferences.
Print out this page, and mail to:

IAS
PO Box 411072
St. Louis, MO 63141

Please check which applies:

General Membership
Individual $30 __
Couple $40 __
Professional Membership
Individual $30 __
Group $100 __
(Group membership includes all members of an organization or company up to six people.)

Personal Information

Name: _____________________________________

Address:____________________________________

City:____________________________State: _________ Zip:_________

Phone: (Home) __________________________

           (Work) __________________________

Email: _______________________________

Names of Group Members:
(if applies)
_____________________________________
_____________________________________
_____________________________________

IAS is a not-for-profit organization supported by your membership dues and donations.

If you are not a member, we hope you will use this membership form to join IAS.

This information is never sold, rented or otherwise provided to advertisers, sponsors or other third parties. IAS, Inc. does, however, send out
information packets from third parties on a periodic basis.

 
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