Membership Application Form

OPERATION IDENTITY

MEMBERSHIP
APPLICATION
FORM

Would you like to become a member of Operation Identity? Annual dues are only $25, and they go to support the activities of Operation Identity, including the newsletter, meetings, and fliers and notices to carry the message of support to all members of the adoption triad. To become a new member, just fill out this convenient electronic application form. Once completed, click the button below to “Go to Step Two” (Select Payment Option).

(Items in RED are REQUIRED, but we encourage you to fill out the form as completely as possible.)

STEP ONE: Complete the Membership Application Form

Persons applying from outside of Canada or the U.S. are encoraged to utilize the hard-copy form.

First Name:

M.I.:

Last Name:

Company/Group:

Address Line 1:

Address Line 2:

City:

State:

Zip®/Postal Code:

Primary Tel. No.: (

)

Alternate Tel. No.: (

)

Ext.

E-Mail:

Website: http://www.

TRIAD Position:

Adoptee
Birth Parent
Adoptive Parent

Adoption Support Group
Adoption Professional
Other

I don’t want to join now, but wish to contribute to support Operation Identity.

Donation Amount: $

(Non-member contributors will also be included on the newsletter mailing list.)