MEMBERSHIP

New members are always welcome! While membership is not mandatory for you to
receive information and support service from our organization, we do urge you to
become a member due to its exceptional benefits. By becoming a member, you will:

Join the fight against lupus
Increase public awareness
Friends, family members, colleagues, supporters, interested community members,
doctors, health practitioners, business owners...you don't have to have lupus yourself to
become a member of the Belize Lupus Association and you don't have to live in the
country of Belize. We welcome new members from all over the world.
It costs just BZ$24 per year to become a member, which then entitles you to up-to-date
information on upcoming seminars and meetings

The membership fees paid to the Belize Lupus Association go towards administration,
merchandise, awareness tools (such as banners and flyers) and many other aspects that
enable us to offer advice and support to the lupus community.

To enquire about becoming a member, please contact the Belize Lupus Association
at 662-9009 or email us at belizelupusassociation@ymail.com.



Return Form
Please complete form and forward with cheque or money order payable to:
Belize Lupus Association,
PO Box 89,
Belmopan,
Belize, C.A.




















Belize Lupus Association
P.O Box 89
Belmopan City, Belize
C.A.
NEW/RENEWAL MEMBERSHIP FORM

Type of Subscription (1 January - 31 December 2014)
(1) $50 Family
(2) $24 Single
(3) $? Donation (Not Mandatory)
Total Enclosed $.

Member Details
Title.. Surname:Given Names........................
Address ..................
P/Code....Phone.. Email: ...............................................................
Date of BirthYear Diagnosed........

Type of Membership (please check)
NEW MEMBERSHIP - please complete sections below.
RENEWED MEMBERSHIP - this form is now complete.

I suffer from/I have a loved one who suffers from (please check)
Systemic Lupus Erythematosus
Discoid lupus
Rheumatoid Arthritis
Raynauds phenomenon
Other.............................................................

Area of lupus involvement (please circle)
Kidneys
Central Nervous System
Thyroid
Joints
Muscles
Tissue
Tendons
Skin
Brain
Lungs
Heart
Eyes
Blood

Other: ................................................

Any Family History (blood relations)?
.............

Volunteering
Can you assist us by volunteering your time? Please provide any details about how you
may be able to assist:
......................................................................................

......................................................................................


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Signature Date