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BASTARD NATION
This is important!
Bastard Nation is not a search service or support group. Bastard Nation engages in political activism to achieve equal rights for adoptees.
Please read our
Mission Statement
to understand what we are about.
Full Membership
Proud Bastards & Friends
$35 - 1 Year
$60 - 2 Year
$85 - 3 Year
$15 - Seniors, Soldiers, Students, Hardship
Additional Donations are always welcomed!
We appreciate your generosity to the cause of open records.
$
.00
Charges are billed in the local currency, not always dollars.
Contact Information:
First Name:
Last Name:
Street Address:
Address Line 2:
City:
State/Province:
Zip:
Country:
United States
Canada
Australia
Austria
Belgium
Belize
Brazil
Chile
Columbia
Costa Rica
Denmark
Ecuador
Egypt
El Salvador
Estonia
Finland
France
Germany
Greece
Guatemala
Honduras
Hungary
Iceland
India
Ireland
Israel
Italy
Jamaica
Japan
Latvia
Lithuania
Luxembourg
Mexico
Netherlands
New Zealand
Nicaragua
Norway
Panama
Pakistan
Paraguay
Peru
Poland
Portugal
Russia
Spain
Sweden
Switzerland
Turkey
Ukraine
United Kingdom
Uruguay
Venezuela
Other ...
Phone:
Fax:
Full E-mail Address:
(e.g.:
ImaBastard@aol.com
)
Alternate E-mail Address:
New (or renewing) Members
Please consider providing the following information:
Triad Position:
(Check all that apply)
[
Adoptee] [
Birthparent] [
Adoptive/Prospective Adoptive Parent] [
Other]
Date of Birth:
(or Ostensible Date)
Day :
Month:
Year:
State/Province/Country you were born:
State/Province/Country you were adopted:
Relevant technical expertise, skills, talents:
(E.g., computers, public relations, legal, political activism. etc.)
Occupation:
How did you hear about Bastard Nation?
Just Browsing
Search Engine
Friend/Relative
Usenet Newsgroup (please specify below)
Mailing List (please specify below)
Magazine (please specify below)
Newspaper (please specify below)
Television (please specify below)
Link from Other Site (please specify below)
Other (please specify below)
Specify:
Other Info:
(Explain here if applying for Hardship rate)
Payment Information:
Bastard Nation accepts payment by check, credit card, money order. Charge your membership online using our secure server, or print this form and mail it with your payment to Bastard Nation at the address below.
Pay with PayPal:
Pay by Credit Card:
Visa
MasterCard
American Express
Card Number:
Expiration Date:
Month:
Year:
CVV Security number:
(printed on card)
Name as it appears on the card:
Bastard Nation
P.O. Box 1469
Edmond, OK 73083-1469
U.S.A.
Send any additional questions or comments to:
members@bastards.org
or call 415-704-3166.
Thank you for your interest in Bastard Nation.
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