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Just print and fill our this form. You may either fax this form to +31(0) 492 599 068 with credit card information
or mail it to any of the addresses provided on the below form.


DONATIONS &
NEW OR RENEWED SUBSCRIPTIONS


Name:


Address:



Current Membership Number:
(For renewals: Can be found above your name on the address label)

* Relationship to CF: (please check one)

I Have CF: My Child/Relative has CF: CF Doc/Nurse/etc: __ CF Association:__

Subscription to the Newsletter (4 issues per year) is £10 sterling, UK ($15.00 U.S.) or the equivalent in your own currency, plus any additional donation, if desired. To determine the exchange rate of your particular monetary currency either check the financial section of your newspaper, call your local bank or visit the following website: http://uk.finance.yahoo.com/m5?a=1&s=USD&t=GBP.

Subscription fee may be waived for CF adults or families facing financial stress.

Cost: CFW is a non-profit making organization which relies upon donations from CF charitable associations and subscriptions to the Newsletter. Each copy of the Newsletter costs the equivalent of approximately US$5 (GB£3) to produce.

Payment Methods: (Please select payment method 1, 2 or 3 below)

1. International Money Order:
Payable to: Bosbes 12, 5708DA , Helmond, The Netherlands Account No: 1148.42.507 Swift code: RaboNL2U

2. Checks Payable to: Cystic Fibrosis Worldwide
Send payment and form to: Christine Noke 56 Central Street Hudson MA 01749 USA

3. Visa, Mastercard or Eurocard:

Charged subscriptions are accepted worldwide. Credit debit will be posted to your account, and will appear on your charge card statement, in your own currency in an amount equivalent to the pound sterling UK amount specified by you below.

Please debit my account for the sum of:

£ Sterling (Regular subscription cost = £10)

Check One: Visa Mastercard Eurocard

Card No: ____________________________________

Expiration Date: _______________


Signed: Date: _______________

Send completed form with credit card information to:

Christine Noke
56 Central Street
Hudson MA 01749 USA		 OR Sam Hillyard
12 Howard Close CARDINGTON Bedfordshire MK44 3SL England
Address Changes and Requests to stop mailing:
Please include the code number printed above your name on the address label.

By E-mail: subscriptions@cfww.org
By Snail-Mail: Christine Noke 56 Central Street Hudson MA 01749 USA OR
Sam Hillyard 12 Howard Close CARDINGTON Bedfordshire MK44 3SL England

* This information is not compulsory, but if completed will be helpful to colleagues working in the field of CF, for research purposes. Subscribers' identities will not be disclosed in this process. If you do not wish your information to be used in this way, please check this box ?