WFH Personal Membership Form

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We encourage members to support the charitable goals of the WFH. Please make a donation to ensure quality healthcare for people with bleeding disorders throughout the world.

I would like to make a charitable donation.

About you

Profile

Please indicate all the categories that apply to you.

Dental professional General practitioner Hematologist Laboratory personnel NMO staff/volunteer Nurse Occupational therapist Orthopedist Pediatrician Person with bleeding disorder/family member Physiatrist Physiotherapist Researcher/Scientist Rheumatologist Social worker/Psychologist Student Other
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I work for:

Treatment center or hospital Industry Government or Regulatory Agency Non-profit organization
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Preferred language of communication: English French Spanish

WFH mailing lists remain confidential and will not be shared with any other organizations.

Publications

I wish to receive Hemophilia World and other WFH publications in the following format:
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Payment information

If paying by money order or by cheque (payable to the World Federation of Hemophilia in US dollars drawn from a US bank or the US correspondent of my local bank), print a copy of this form and mail the completed form to: 1425 René Lévesque Boulevard West, Suite 1010, Montréal, Québec  H3G 1T7 Canada.

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Please click on "continue" below to complete your transaction. This will bring you to our secure server (Moneris - online, real-time credit card processing).

THANK YOU!



All data will be sent using our secure server (Moneris) and cannot be observed by a third party. We value your information and your privacy, and have taken steps to assure that your data is secure with the WFH. This information will be kept confidential.