Phone: 800-926-4797 or 941-312-0400

Membership & Donation Form

Paying by Check?

Download this form - click here
Send Checks to:
PWSA (USA)
8588 Potter Park Drive, Suite 500
Sarasota, FL 34238

Remember, NO PARENT IS EVER DENIED MEMBERSHIP. If you cannot afford to pay, simply call our 800 # (800-926-4797) and tell the staff. No questions are asked. Together we can make a difference. Sign up TODAY!

Mastercard, Visa, and Discover are accepted

* Required Fields

*Name:
*Address:
*City:		State:	PostalCode:
*Providence/Country:
*Telephone: use dashes (XXX-XXX-XXXX)
*Email:	used for Emailed Newsletter
Membership Renewals - Check your membership renewal form (enter codes from above your name)

* GO GREEN! “The Gathered View” newsletter will be emailed unless you indicate below for a paper version: Please mail a paper version

Are you a PWSA Chapter Member?
Yes No

If Yes, which chapter?

Type of Memberships
Individuals, Families, Professionals, Organizations, Auxiliary

Families and Individuals
What is your relationship to the person(s) with Prader-Willi Syndrome?
Name of family member with PWS:
Date of Birth:	Sex:

Professionals, Organizations, others

Choose the one that best describes your position or interest with respect to Prader-Willi Syndrome:

If Medical Professional, Specialty.

If your profession/organization was not listed above, please specify.

*Auxiliary Membership (Anyone with a current membership can sponsor and pay for other people as auxiliary members for a special auxiliary membership fee, which entitles that auxiliary member to receive the Gathered View and be on our mailing list. Accepted Auxiliary Memberships would be a relative, doctor, therapist, educator, etc.)

For Each Auxiliary please fill out this form... Click here and also list them here. Payment must be filled in below,

Donations
*Note: "In Memory" or "Honor of" can be
designated in specific funds or entered in top box.

Pull down for In Memory or In Honor of
Enter Name here:
Click here for descriptions

Please Notify (Name & address) of my contribution

No Designation

Endowment

Angel Fund

Research Fund

Membership

*New Members with a child under 5, please call 1-800-926-4797 before continuing!

Renewal New
Permission for PWSA (USA) to contact you, if needed?
Permission for PWSA (USA) to share your information to your state chapter (if one exits)

All Payments are in U.S. Funds

Family - $50.00
or $60.00 Outside of U.S.

**Sponsored Family - $50.00 or more

*Auxiliary Memberships - Each -$15.00 or $25.00 Outside U.S.

Total $

Click on Calculate Results before clicking on Submit.

*Auxiliary memberships may be purchased with your membership or renewed/removed with your annual membership renewal. If you would like to sign up new auxiliary members before your renewal date, please call the office at 800.926-4797

**Sponsored Family... Many families cannot pay membership fees, but need support that PWSA (USA) will provide. If you would like to show your support for this please choose "sponsored family" membership on the payment form and include the additional amount with your payment.