Membership Application

Online Membership Application

Thank you for your interest in Families for Russian and Ukrainian Adoption (FRUA).
Please answer the questions below (it is not mandatory to answer all questions). If you have not as yet adopted a child, please fill out as much as you can at this time.

Membership fees are listed below. Please check the appropriate Regional or National box and send your check, payable to FRUA, to: FRUA, P.O. Box 2944, Merrifield, VA 22116. Please note on the check that you submitted your form via the web site.

If you have any questions, call our voice mail box at 703-560-6184. Go HERE for Regional contact names and phone numbers. Please allow 6-8 weeks for the arrival of your welcome package.

First time Member Renewal Membership

Check PayPal

Please choose a chapter:

Tax deductible donation $

Friends-Under$100 --- Sponsors-$100-$499 --- Benefactors-$500-$999
Philanthropist's Circle-$1,000-$9,999 --- Heritage Society-$10,000+

All donors will be listed by these designations in our newsletter. If you
DO NOT wish to be acknowledged by name in our newsletter, please check
here:

Adoption completed Adoption in progress Considering adoption

Parent Name :
Occupation:

Parent Name:
Occupation:

Address
City ST Zip:

E-mail: Phone:
Fax:

CHILD(REN)'S INFORMATION

	Adopted Child's Name	Date of Birth:	Date of Adoption	Orphanage City	Country
1.
2.
3.

	Biological Child's Name	& Date of Birth:
1.
2.
3.

What Agency did you use?

Did your child(ren) have any medical issues? Yes No

If yes, what was the diagnosis, and how is the problem now?

How did you learn about FRUA?

Would you be interested in helping out with a local chapter or one of our other committees?
Yes No

How can FRUA help you?

Are you willing to share this information with other adoptive families in our group?
Yes No

After submitting your application please use your web browsers print function to print a copy of the confirmation page. Please include a copy of the confirmation page with your payment.

Click on the PayPal link below to make your dues payment. Be sure to make note of the dues amount for your chapter.

Please enter your chapters name in the "Item" box and your chapters dues amount in the "Item Price" box on the PayPal screen.

According to PayPal you must have cookies enabled for this process to work.