MEMBERSHIP APPLICATION

(The membership year runs from January 1 through December 31.  Any new member who joins after September 1,  will have membership through the following year.)

THREE WAYS TO JOIN THE HUMAN GROWTH FOUNDATION

I.  APPLY FOR HGF MEMBERSHIP ONLINE:
      A. Click on the Print Friendly Membership Application

           Requires Adobe Acrobat Reader, Version 7.0 or later. You can download the Adobe Acrobat Reader by clicking on            icon above, next to hyperlink to the application.   Complete the application; then use the (a; ) Print button to make            a copy for yourself   followed;  by (b) the Submit by E-Mail Button, to send the form to HGF as an            attachment. There is room for a note in the body of the e-mail  message.
         
       B.  Pay for HGF Membership Online:  Follow the instructions under Methods of Payment BELOW

II.    APPLY FOR HGF MEMBERSHIP WITH CHECK OR MONEY ORDER:
       A.   Complete online and print out the Print-Friendly Membership Application

       B.   Mail the membership application and check or money order made payable to the "Human Growth Foundation"              at the address below.

III.   DOING IT THE HARD WAY (IF YOU MUST:

       Print this entire page; complete the membership application below in pen and ink; and mail the entire page)
       with a check or money order made payable to the  "Human Growth Growth Foundation, at the address below.

First Name: _______________________________ Last Name: _______________________

Primary Occupation: _________________________________________________________

Position Title: _______________________________________________________________

Business: __________________________________________________________________

Home Address: ______________________________________________________________

City/State/Zip:________________________________________________________________

Business Phone: (_____) ________-__________ Home Phone: (_____) _______ - ________

E-Mail Address:______________________________________________________________

Type of Membership: NEW______ RENEW______ (all contributions are tax deductible)

Method of Payment: __ Check  __ Money Order  __ Credit Card  (Membership dues must be paid in U.S. currency)

__Family            ($50)      __Institutional                          ($200)   __Supporting     ($75)    __Century Club-personal   ($1,000) __Donor            ($100)  __Century Club-corporate  ($1,500)

If this is a gift membership, name and address of Donor:_______________________________________________________________________________

_______________________________________________________________________________

Type of growth/growth hormone that interests you:________________________________________ _______________________________________________________________________________

Optional: Your doctor's name and address:________________________________________________________________________

_______________________________________________________________________________

Optional: Child's Name:______________________________________  DOB:__________________

Optional:Diagnosis: _______________________________________________________________

METHODS OF PAYMENT A.   CHECK OR MONEY ORDER        Please make check or money order payable to:  "Human Growth Foundation"        Mail check or money order with the completed print version of Print Friendly Membership        Application, or completed pen and ink applicastion (page) to:        Human Growth Foundation        997 Glen Cove Avenue # 5        Glen Head, N.Y. 11545 B.  PAYPAL OR CREDIT CARD VIA PAYPAL       It's fast, free and secure!       You can pay with PayPal or with a credit card through PayPal.  All major credit cards are accepted. A       PayPal account is not required.       Simply select a Membership type from the dropdown below and click on the "Pay Now" button for       access to the PayPal and credit card options.       If you are using a credit card option, click on "Continue" hyperlink on the right side of the page       adjacent to the PayPal option; and follow the instructions.       NOTE: All but the Century Club memberships dues have increased in price. This is the first       increase in membership dues in more than 12 years!       If you have any difficulty, with executing online payment, please contact the Webmaster Select a Membership Type Family - $50 Support - $75 Donor - $100 Institutional - $200 Century Club - Personal - $1,000 option> value="1500.00">Century Club - Corporate- $1,500 The Human Growth Foundation helps children and adults with disorders related to growth and growth hormone  through education, research, support, and advocacy. Your tax deductible membership fee will help sustain the activities and programs supported by the Foundation.