FAMILY MEMBERSHIP FORM    Southern Tier Adoptive Families  PO Box 930   Vestal, NY 13850

$20 per family    $45 professional or agency      (circle one)        Please completely fill out the form below.  This information helps STAF plan activities for adoptive and pre-adoptive families.  Membership dues are $20 per year.  Although our membership year runs from Oct – Sept, families can join at any time. Please include a check made out to Southern Tier Adoptive Families. Thanks for your support!                      

Date: _______        Names: ____________________________________________

Address: __________________________________________________________________

Phone: ____________     Email: ______________________

Want to have your address & phone number in STAF directory?  
(distributed only to members)   Yes  or  No

Want to join our STAF listserv at STAF@yahoogroups.com?      Yes  or  No

Are you currently pursuing an adoption?   Yes  or   No

My/Our stage in the adoption process is: ____________________________

Please list all children in your family (adopted and birth children):  
Include child’s name, birth date, arrival date, and country.

Please use a “P” to mark the activities your family might participate in and/or an “A” for those they can assist with:

____ Annual Sept “Kick-off” Picnic                             ____ Adult Discussion Groups

____ Sports Events (hockey, baseball games)            ____ Winter Holiday Party 

____ Halloween Costume Party                                ____ Adoption Info Seminar (April/May)    

____ Summer Picnic (June)                                     ____ Playgroup            

MAIL TO:  Southern Tier Adoptive Families     PO Box 930  Vestal, NY 13851-0903