Membership in the Phoenix Ostomy Chapter, Inc. provides you with The Phoenix, our chapter newsletter. Please print out the application and mail with your check to the address below. Newsletters are mailed to members and contributors monthly. Inquirers receive 3 complimentary copies, after which we encourage you to join and become a member or make a donation.
HOMEPAGE-PHOENIX OSTOMY CHAPTER
PHOENIX OSTOMY CHAPTER MEMBERSHIP APPLICATON
NAME___________________________________________________
ADDRESS________________________________________________
CITY________________STATE___________zip__________
PHONE_____________________BIRTHDATE____________
I have a ___Colostomy___Ileostomy___Urostomy___Continent Ostomy___Other
Reason for surgery_________________________________________________
Date of surgery_____________________Hospital________________
Amount Enclosed_______
Membership $10.00
Please make checks payable to:
PHOENIX OSTOMY CHAPTER, INC.