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ANA Membership


  1. Your ANA membership entitles you to the following benefits:

    • Receipt of our quarterly ANA newsletter, Notes, with the latest medical information on acoustic neuroma (access to this is available in the website Member Section at least two to three weeks prior to receiving mailed copy)
    • Access to an exclusive Member Section on our website, including published medical journal articles on acoustic neuroma, patient information booklets, webinars with an acoustic neuroma medical professional, symposium presentations and our newsletter archived with current and past issues
    • Webinar participation presented by acoustic neuroma professionals.
    • Invitations to our network of local support group meetings across the U.S. for your area

    Your membership and donation also supports the following vital patient-focused programs including:

    • Availability of patient information booklets on all aspects of acoustic neuroma pre- and post-treatment care, that can be downloaded in the exclusive website Member Section
    • ANetwork, Nationwide Peer Support Program
    • Research on acoustic neuroma, most recently with the 2014 patient survey
    • Access to our website with our ANA Discussion Forum
    • Presence on social media sites including Facebook, Twitter and YouTube

    The ANA Board of Directors advises that names and addresses gathered here are used only to mail a quarterly newsletter, inform members about local support group meetings and send other official ANA mailings. Names are not used for any commercial purposes and the data is not sold. Member names are not shared with other members without first asking permission.

    This site is secure for credit card transactions.

    Please complete the information in this form and press the "Submit" button at the bottom.

    Note that items marked with an "*" are required fields.




  2. Please send all future information electronically.
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  3. Annual Membership Dues (*)

    Please select a membership level:

  4. (*)







    Please select a membership level.

  5. My Support of ANA

    Please also consider a tax deductible contribution to ANA.
    Please enter your donation amount in whole dollars, with no decimal places.

    Category Amount
    ANArchAngel$5000 and above
    ANAngel$2500-$4999
    Grand Benefactor$1000-$2499
    Benefactor$500-$999
    ANA Patron$250-$499
    ANA Donor$100-$249
    ANA Friend$50-$99

  6. Donation Amount
    This field should contain a dollar amount, with no cents and no dollar sign.
  7. Total Dues and Donation Amount
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  8. (In dollars, no cents, no dollar sign.)

  9. Tribute Gift - Do you wish to make a special tribute gift?
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  10. Matching Gift - Is your employer matching your donation?
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  11. Please respond to a few questions so we can serve your better. All information received is confidential.


  12. Patient Type(*)
    Please select a patient type.
  13. Tumor Size
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  14. Approximate Diagnosis Date
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  15. Treatment Type
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  16. Occupation
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  17. Birthdate
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  18. For future information from ANA, you can help ANA save printing and mailing expenses by accessing information online and receiving information via email.

    Please email us at info@anausa.org if you wish to go electronic or have a new mailing address, email or phone number.




  19.  
  1. Matching Gift Information

    We are so grateful for employers that match donations! So we may collect your employer's information, please complete the fields below.


    (If possible, please mail, fax, or email your employer's matching gift form.)


  2. Company Name
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  3. Address 1
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  4. Address 2
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  5. City
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  6. State
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  7. Zip/Postal Code
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  8.  
  1. Tribute Gift Information


    Please enter information below to make a tribute gift.


  2. Tribute Gift


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  3. Name
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  4. Please Notify (name)
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  5. Address 1
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  6. Address 2
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  7. City
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  8. State/Province
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  9. Country
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  10. Zip/Postal Code
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  11.  
  1. Payment Information

    We accept Visa and MasterCard ONLY

  2. Payment Amount(*)
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  3. First Name(*)
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  4. Last Name(*)
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  5. Credit Card Number(*)
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  6. Only Visa accepted  MasterCard accepted accepted

  7. CCV(*)
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  8. For most credit cards the CCV is 3 numbers located on the back of your credit card, near or on the signature bar.

  9. Expiration Date(*)
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  10. Billing Address(*)
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  11. Billing Address 2
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  12. City(*)
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  13. Country(*)
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  14. State / Province / Region(*)
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  15. Zip / Postal Code(*)
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  16. Home Phone
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  17. Cell Phone
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  18. Email(*)
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  19. Consider Other Gift Options

    Acoustic Neuroma Legacy Society: A planned gift today is a wonderful way to pass on your legacy tomorrow. Planned gifts include bequests, appreciated assets such as stocks, charitable remainder trusts and charitable gift annuities.

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