United Ostomy Associations of America, Inc.   Membership Application    
 
 Home
 Officers
 WOC Nurses
 Resources
 Meetings
 Newsletters
 Join
 Links
 Gallery
 Hints&Tips
 Member Mail
 Contact Us

RALEIGH AREA CHAPTER UNITED OSTOMY ASSOCIATION

Name: Date:
Telephone: E-Mail:
Mailing Address:
 
City, State, Zip:
Year of Surgery: Spouse's Name:
Type of Surgery:
(Check all that apply)
[] Colostomy [] Ileostomy [] Urostomy (Ileal Conduit)
[] Other:
[] I am not an ostomate but would like to be a member.
[] I cannot afford the dues but would like to be a member. (Confidential)

We welcome the membership of ostomates and other persons interested in the United Ostomy Association and its activities and appreciate the help they can provide as members. To join, print the form (in landscape mode), complete and send it with a check or money order for $20.00 made payable to Raleigh Area UOA
to:

Mrs. Ruth Rhodes
6616 Rest Haven Drive
Raleigh, NC 27612

Dues cover membership in both the local chapter and the national organization, including subscriptions to the national Ostomy Quarterly and the local By-Pass.




United Ostomy Associations of America