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February 26, 2024
10:51 am
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Support and Prayer Request Form
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Financial Assistance Form
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What is your relationship to infertility?
I am a friend or family member of someone with infertility.
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I/We have decided to live without children
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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.)
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Surrogacy Intent Form
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Surrogacy Information**
Are you interested in becoming a surrogate or seeking a surrogate
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Have you previously participated in a surrogacy arrangement?
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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?
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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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