So you'd like to join the club? Great!!!

I wish I could bring this newsletter to you for free, but unfortunately, that's not the case in today's costly world. However, I'm offering membership in the club for just $9.95 a year (to cover printing and postal costs). Don't you think it's worth 83 cents a month to meet new friends, share experiences and learn more about your body and why it does what it does? This will include 12 issues of "The PCOS Pages" which will be mailed to you every month. Also, you will receive 1-2 emails per month with the survey questions and member-related announcements.

To join the club, please fill out the following form:
(fields with a * are required, but please fill out all that you are comfortable with)

***I will contact you by email soon after you send this form***

* Name:
* Address:
* City:
* State/Province:
* Zip/Postal Code:
Phone Number:
* Birthdate (mm/dd/yyyy):
Anniversary (if married):
* Age Diagnosed with PCOS:
* Email Address:
Your Web Page URL:
Your Doctor's Name:
What practice is your doctor? (Endo, OB/GYN, etc.):
What medicines/herbs/supplements do you take right now, and what for specifically:
What symptoms do you experience with your PCOS (please list all you can possibly think of):
What is your current height?
What is your current weight?
How much would you like to weigh?
Are you currently trying to conceive?
Do you currently have a somewhat normal menstrual cycle?
What is your current occupation?
What is your favorite color?
What is your favorite food(s)?
Would you be interested in sharing your story in the newsletter?
Please type your initials to act as your signature if it will be okay if this information is printed in a future member directory:
How would you like to pay your $9.95 fees? (with PayPal or by check through mail)