Broward Ostomy Association Membership
If you wish to be a member of BOA, dues are $10.00 per year from January 1st to December 31st which includes receiving our quarterly newsletter, the Broward Beacon. Please make checks payable to BOA, print and fill out a copy of this page and mail to: The Lueders, 2100 S Ocean Dr #16M, Ft Lauderdale, FL 33316
Name _________________________ Age ____ Year of Surgery________
Street _________________________ Apt. ____ Type of Ostomy________
City _________________________ State ___ Zip _______ Phone (___) _________
e-mail address: __________________________________
___ I would prefer to receive a printed copy of BOA’s Newsletter The Broward Beacon OR
___ I would prefer to receive an emailed copy of BOA’s Newsletter The Broward Beacon
__ I am an ostomate. I would like to become a dues paying member.
__ I am also enclosing a contribution for BOA.
__ I am an ostomate and would like to become a member but cannot afford dues at this time. (This information is kept in the strictest confidence.)
__ I would like to become an Associate Member (non-ostomate).