Membership Application

EMPOWER YOURSELF!
BECOME A MEMBER

By joining NYCCHCD and becoming a member, you support the non-partisan community outreach work NYCCHCD performs every day of the year. You will also receive our newsletters, mailings and invitations to our events (and a link to your organization's website site if you are an institution). Please call 212-586-4638 to become a member.

Yes, I would like to become a member of the New York Citizens' Committee on Health Care Decisions (NYCCHCD), which entitles me to:

receive your newsletter, "Citizen Voices in Health Ethics";
attend your educational forums for a reduced fee;
take part in the "Let's Talk" discussion series for members.

Enclosed please find my membership contribution in the amount indicated:

O $35 Individual	O $200 Benefactor
O $60 Family	O I would like to make an additional contribution in the amount of $______________.
O $100 Institution

Name (Ms., Mrs., Miss, Mr.):

_________________________________________

Tel.:

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Title:

_________________________________________

Fax.:

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Address:

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E-mail:

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Please print and mail the application with check(s) payable to:

NYCCHCD
39 Broadway, Suite 200
New York, NY 10006

Your contribution is tax deductible to the extent provided by law.

The New York Citizens' Committee on Health Care Decisions is a non-profit, non-partisan grassroots initiative dedicated to greater citizen involvement in formulation of health care policy. It provides impartial forums for discussion of today's crucial and ever more complex health care issues.

At the same time technological and scientific advances are pushing medical frontiers forward, radically changing what we can do, they are also generating new moral quandaries that force us to ask what we should do, about artificial life supports, fair access to care, equitable distribution of resources, physician-assisted suicide, physician-patient collaboration, etc.

Because the Citizens' Committee believes that a participatory citizenry must be an informed citizenry, we encourage the expression of individual concerns and values.

Along with like-minded organizations in twenty other states, the Citizens' Committee is a member of American Health Decisions, a national coalition of state citizen groups concerned with health care policy and ethics.