MEMBERSHIP FORM

MEMBER PARTICULARS

First Name

Last Name

Address

City

State/Province

Zip/Post Code

Country

Phone

Fax

Email

MEMBERSHIP PREFERENCE

Let us know what Username and Password would you like to have in order for you to log into the Member Lounge after your membership has been approved.

NB: Username and password are case sensitive

Username

Password

CONTRIBUTION AMOUNT

Please let us know what is the amount you wish to contribute? You may choose to contribute in either US fund or Canadian fund (Minimum USD$10.00 or CAD$15.00)

Contribution Amount

CONTRIBUTION INSTRUCTIONS

1. Ensure all information is valid especially your email address as your personal Username and Password as well as a Serial Number (for registration of GenderLabs™ v1.3 Fertility Management System) will be emailed to you directly.

2. Print a hard copy and make sure the contents are legible and,

3. Prepare check, money order or bank draft payable to Areddot Inc. (payment facilitator of GenderLabs.com) for the amount in US Fund or the equivalent in Canadian Fund which you have indicated above.

4. Send the payment together with the Membership Form by mail to Areddot Inc. with address as below: -