Guatemala Adoptive Families Network -- Membership Form

     Ready to join?  Just print this form, fill it out, and mail it to us at the
     address shown.  Don't forget to include your annual dues of $20 per family
     for 2005, and your contribution for Material Aid.

     Name _______________________________________________________________

     Address ____________________________________________________________

             ____________________________________________________________

     City, State/Province _______________________________________________

     Postal Code, Country _______________________________________________

     Telephone __________________________________________________________

     EMail ______________________________________________________________

     Please list the name (optional), age, and the year the
     child joined your family, for each of your children adopted
     from Guatemala (if applicable):

          _______________________________________________________________

          _______________________________________________________________

     Please check any committee(s) you can work on to help carry
     out our volunteer, grassroots efforts:

           ___ Material Assistance     ___ Publications and Media
           ___ Adoption Information    ___ Membership and Administration
           ___ Public Relations        ___ Fundraising and Development

     Membership type:
        ___ Standard -- please check a category below:
               ___ Family with child(ren) adopted from Guatemala
               ___ Family awaiting a Guatemalan child
               ___ Extended family member of one of the above
               ___ Guatemalan adoptee
        ___ Associate (adoption professionals and others)

     Amounts enclosed:

         2005 dues ($20 US/family)                     _______________

         Contribution for Material Aid*                _______________

         Additional contribution for Guatemala         _______________
         Adoptive Families Network operations

     Total enclosed                                    _______________

     Complete this form and mail with your check or money order to:
     Guatemala Adoptive Families Network, P.O.Box 176, Watertown,
     MA 02471, USA.  Contributions are not tax-deductible at this
     time (we're working on it).

     * 100% of Material Aid contributions will go to material aid
     projects.  The Network is dues-supported and does not take any
     administrative or other fees from material aid contributions.