PCOSupport™; Donations Form

For information on
website advertising,
please contact the PCOSA's
IT Department:
it@pcosupport.org

Help support the PCOSA become a member, make a donation, or volunteer

~~ Happy 10th Birthday PCOSA ~~

Thank you for making a donation to the PCOSA!

We provide patient support services, educational conferences, medical education programs and research support services as well as media and community advocacy programs. Individual and commemorative donations help us as we work to raise PCOS awareness. We could not do this work without your ongoing support.

Please fill out the information below for each individual who wishes to become a member of PCOSA. Credit card payments for individuals outside the US will be processed at the current exchange rate on the date of transaction. Please note that the date of transaction may not correspond with the date of application.

The PCOSA does not sell or distribute personal information. Personal information provided is for PCOSA use only.

If you wish, you can print this form and mail it to:

PCOSA, Inc
PO Box 3403
Englewood, CO 80111

Donor Information:

Would you like to make a Donation to PCOSupport? If so, please enter the dollar amount below.

Would you like an e-mail or postal mail commemorative certificate?
Postal Mail
E-mail

NOTE: Email certificates are sent as an Adobe Acrobat Reader (pdf) file and are identical to certificates sent by regular mail.

Please enter the name and address of the person you wish to send the certificate to in the area below:
Enter information here for Certificate

Mailing Address Information:

Name:
Address:
City:
State/Province (US or Canada Only):
Zip/Postal Code:
Country:
Home Phone (Area or Country Code first):
E-mail Address:

Further Information:

How did you hear about us?

Web site
Email List
Newsgroup
Other (please specify):

Please print and mail this page along with your donation to the address above.

Download Acrobat Reader