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Support and Prayer Request Form
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Type of Request (Please select all that apply):
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Details of Your Request:
Would you like to receive updates and newsletters from us?
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Is there any additional information you would like to provide that might help us better understand your needs?
Consent and Acknowledgement
I hereby declare that the information provided in this form is true and accurate to the best of my knowledge. I understand that Gift Of Life Foundation will review this information and may contact me for further discussion or support.
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Financial Assistance Form
Full Name
Email
Phone
Date of Birth
Gender
Male
Female
Address
City
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Zip
What is your relationship to infertility?
I am a friend or family member of someone with infertility.
I am a Professional who serves the infertility community
I/We have been diagnosed with infertility
I/We have decided to live without children
I/We have resolved and have completed building my family
Other
Are you currently a volunteer for Gift of Life Foundation?
Yes
No
Is there a specific date for your fundraising effort? Yes, what date?
Is your fundraiser a Do-It-Yourself Walk of Hope? (If yes, you may skip the rest of the questions and a Gift of Life Foundation staff member will contact you.)
Yes
No
Will you be selling something to raise money for Gift of Life Foundation?
Yes
No
Will you be asking people to donate in honor of or in tribute to someone or some milestone event (such as a birthday, retirement, significant accomplishment, etc.) ?
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No
Will you be asking other people to also fundraise for Gift of Life Foundation as part of your event/activity?
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No
Do you work for the U.S. Government?
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No
Message
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Surrogacy Intent Form
Full Name
Email
Phone
Date of Birth
Gender
Male
Female
Address
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**
Surrogacy Information**
Are you interested in becoming a surrogate or seeking a surrogate
Becoming a Surrogate
Seeking a Surrogate
Have you previously participated in a surrogacy arrangement?
Yes
No
If yes, please provide details:
Motivation for Surrogacy (Please explain your reasons for wanting to become or seek a surrogate)
Are you currently working with a surrogacy agency or consultant?
Yes
No
If yes, please provide the name and contact information of the agency/consultant:**
Do you have any specific preferences or requirements for the surrogacy arrangement?
Any additional comments or information you would like to provide:**
Consent and Acknowledgement
I hereby declare that the information provided in this form is true and accurate to the best of my knowledge. I understand that this form is an expression of interest and does not constitute a binding agreement. I acknowledge that Gift Of Life Foundation will review this information and may contact me for further discussion.
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