Fit To Be Untied

Inspiring Voyages to Fertility

Fit To Be Untied Funding List Application

In order to be eligible for funding, you must first read and accept the terms and conditions, found here.
The current Funding List can be viewed here.
Please complete the following funding list application. All fields marked with an asterisk (*) are required.

First Name*
Last Name*
Forum Screen Name
Email Address*

Date of Birth*

Address*
Apt # / Lot / Unit (Specify)
City*, State/Province*, Postal Code*  
Country*
Telephone Number*
Spouse/Significant Other/Partner's Name
Date of Tubal Ligation
Type of Tubal Ligation Performed
Name of Reversal Doctor
How did you find out about Fit To Be Untied?
Do you have any fundraising ideas?
How do you plan on making your dues payment?*
I agree to the Terms and Conditions (Required)