NUFF Membership/Donation Form

Please fill out the information below, print this page and mail it with your donation to:

National Uterine Fibroids Foundation
PO Box 9688
Colorado Springs, CO 80932

First/Last Name:
Address:
City:
State:   Zip:
Country:
Home Phone:
Office Phone:
Fax:
E-mail Address:
Membership/
Donation Amount:

Membership (Includes monthly online newsletter.)

   


Donation (includes Membership)

Other: $

Optional for Memorial or Tribute Donation

In Memory of:
In Honor of:
Please send acknowledgment to:
Name:
Address:
City:
State: Zip:
Country:
E-mail Address:

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This page last updated Friday, August 27, 2004