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


Membership & Donation Form

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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!

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Membership Renewals -
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* GO GREEN! “The Gathered View” newsletter will be emailed unless
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Are you a PWSA Chapter Member?
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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:
 

Please Notify (Name & address) of my  contribution
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Endowment $
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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.


 

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