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Become a Professional Member!


Thank you for your interest in becoming a professional member of our international network! We are delighted that you have decided to join our community.

Once we receive your completed form, we will send you either an email or postcard that will serve as your receipt. The note will include information that you will need to create your Professional Member page in the Portrait Gallery section of our site. 

  • Your page can be customized to meet your needs, and may include a photo, biographical information (personal), abbreviated CV, areas of special interest and expertise, contact information and a link to your department/practice URL.

  • It is our hope that this section will help our site visitors locate health professionals with specific areas of expertise. With your support, this section will evolve into a valuable resource for our international audience.

Newsletters and brochures that may be distributed to your patients will be available to you upon request.

For residents of the United States, a portion of the annual membership is tax-deductible:

Type

Annual Dues

Tax Deduction

Health Professional $ 35

$ 30

Donor $ 50

$ 45

Sponsor $100

$ 95

Benefactor $250

$ 245

Donations without membership, and memorials or tributes are also welcome.  Click here for more information.

If you join online with a credit card using our secure ordering system, you will have immediate access to our support groups, including PDHeart!

Renewals: if you are renewing your membership, please click here for the shorter membership renewal form.

Thank you for supporting our efforts!


 
 

Professional Membership

(click here for the Family Membership Application)

If you have any questions, please feel free to contact us either by phone or email.


 
 

I/We wish to join C.H.I.N. at this level:

$ 35 / Professional
$ 50 / Donor
$100 / Sponsor
$250 / Benefactor

Other: $
 
 
 
 

Please tell us about yourself

 
  First Name  
  Last Name  
  Organization  
  Mailing Address
 
  City  
  State/Province  
  Zip/Postal Code  
  Country  
 
 
  Daytime Phone  
 
 
  Please provide your email address below or enter "None" if you don't have an email address.  We will use this address to contact you, and this is the address that will be authorized to subscribe to our restricted support and information lists.  Please double-check your entry to make sure it is correct.  
  Email Address  
 
 
  What is your Occupation?  
  What is your hospital/practice affiliation?  
  Do you have a subspecialty
or special interests?
 

If you are currently a member of the C.H.I.N. online discussion groups, please tell us which ones:

Update Lists:

Chat Update
Site Update

ACHD
CHDAware
CHDL
GPCHD
HLHS
HTX
PCNurse
PDHeart
PTCHD 
SACHD 
 
 
 

Suggestions and Comments


(Comments can also be mailed to mb@tchin.org)

 
 
 
  Your contact and personal information will be kept strictly confidential, and will not be shared with anyone without your express written or electronic permission.   
 

Once you submit this form, you will be taken to a confirmation page, where you will be given the option to contribute securely online with a credit card, or by mail.

Thank you again for your support!

 
 

 
      

Please report problems with this form to <sysadmin@tchin.org>

 

Donations without Membership

If you would like to support our organization and Congenital Heart Defect Awareness Day without joining, you can make a one-time tax-deductible donation securely with a credit card or check. Be assured that we respect your privacy and do not share information about our donors or members with anyone.

Click the banner on the right to help support our organization!


Make a Donation! Click to begin...
Click for more...

 

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