JOIN
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:
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?
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: