Parents for Heart of Minnesota, Inc

2008 Parents for Heart of Minnesota, Inc. Membership Statement

Family Membership: $18.00 Professional Membership: $30.00

Statements are due by February 28, 2008. Members will receive our newsletter and have voting and

library privileges. Membership will not be denied due to inability to pay. We ask that everyone

keep our records current by filling in and returning the information below.

Your donation is tax deductible. Please check with your employer to see if you have a company

Match donation program in place

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Parent’s name(s)

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Heart Child’s name Sex Birth Date Siblings name(s)

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Address

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City State/Province Zip/Mail Code

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Telephone (Please include are code) E-Mail Address

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Diagnosis

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Surgery? Awaiting surgery? Pacemaker?

______________________________________________________________________________

Cardiologist Surgeon Hospital

Do we hare you permission to recognize your child’s birthday in our Newsletter? Yes / No

What would you like to see in future newsletters or meetings? Other comments? Joys and/or concerns?

______________________________________________________________________________

Please make your check payable to Parents for Heart of MN, Inc. Thanks for your contribution!

Mail to: Parents for Heart of MN, Inc. E-Mail: mailinglist@parentsforheart.org

Attn: 32-P190

2525 Chicago Avenue South Website: www.parentsforheart.org

Minneapolis, MN 55404