TxCARE

Membership
Application

Print and mail together with your check or money order to::

TxCARE Membership
c/o Martha Fralia
4920 Vega Court West
Fort Worth, TX 76133

I want to be a TxCARE Member! Enclosed is my annual dues payment.*

Name_______________________________________________________________
Postal Address_____________________________________________________
City/State/Country_________________________________________________
Zip Code____________________ Phone_________________________________
E-mail ____________________________
Triad Position (Choose one or more):
    ____ Adult Adoptee     ____ Adoptive Parent     ____ Birth Parent
    ____ Adoption Professional       ____ Other: _______________________
Membership CategoryDues per memberNumber Total Dues
Individual@ $ 30.00 each ______ $ __________
Household add-on@ $15.00 each ______ $ __________
Gift Memberships@ $30.00 each ______ $ __________
Additional Contribution $ __________
Total Amount Enclosed: $ __________
I am willing to help TxCARE in the following way(s)
[__] Circulating Petitions
[__] Calling Volunteers
[__] Writing or Faxing Letters to Lawmakers
[__] Distributing Adoption Information In My Area
[__] Fund Raising
[__] Other______________________________________
MISSION STATEMENT
The mission is to promote an adoption system based on honesty and trust that protects the interest of the adoptee, birth family, and adoptive family, while placing the adopteešs interest first if there is a conflict.

VISION STATEMENT
To see adult adoptees have access to their original Texas birth certificates and court records and to promote improved integrity in adoption law.

By signing your name below, you acknowledge that you agree with the Mission and Vision statement of TxCARE and support both.

Signature:_______________________________________ Date:_____________

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Last updated Oct. 12, 2002