Please complete the application below and click submit. Your application will be reviewed and, upon acceptance, added to the list within 24 hours of receipt. The information given below qualifies individuals for participation in the mailing list. This information will never be released or sold to any individual or company. It is needed to ensure that only individuals with an interest in the list topic are admitted to this online support group. Thank you. BEFORE YOU SUBMIT Please recheck your e-mail address to ensure it is accurate. If we do not receive the correct e-mail address, it will be impossible for us to contact you to let you know that the server cannot reach you. We do NOT reject applications without contacting the applicant to discuss why they are being rejected. So if you do not hear from Fortility within 48 hours, you can assume there is some problem with your e-mail address. Either re-submit or contact the moderators directly.

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Email

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Create the password that you want to use to access the list Archives and Account Management website.

Age

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How long have you experienced fertility problems?

Never 1-2 years 2-3 Years 3-4 Years 4-5 Years 5+ Years

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Have you had any pregnancies?

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If yes, how many went to term?

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