Surrogate Mothers Online Listserv Application

Application for Membership

Please Note: Fields that begin with a * are required. When you are subscribed, our moderator will send a message to the group introducing you to the other members. This message will contain your first name, email address and location (city, state). Rest assured that this information will not be divulged to anyone other than group members and all other information will remain confidential and for our records only. There is one exception to this confidentiality clause and it is as follows: We at SMO reserve the right to reveal your identity (or whatever information we know about you) in the event of a complaint or legal action arising from any message posted by you.

* Name(s):
* Email Address:
* City:
* State or Province:
* Country:
* Phone:

* Age:

18-24
35-39

25-29
40-44

30-34
45+

Do you presently have any children? Yes No
If yes, how many?

Is your family complete or would you like to have more children?
Yes, my family is complete.
No, I would like to expand my family in the future.
I am not sure.

* What is your interest in surrogacy?
Considering Becoming a Surrogate
Considering Parenthood Via Surrogacy
Potential or Current Surrogate
Potential Parent(s) Via Surrogacy
Previous Surrogate
Successful Parents Via Surrogacy
Egg Donor

* Which type of surrogacy interests you?
Traditional (AI or IVF)
Gestational (IVF)
No Preference
Undecided

* If you are currently pursuing a surrogacy arrangement, what stage are you in? (Check all that apply)
Gathering info
Choosing an agency
Searching for or waiting to be matched with a couple or surrogate
Matched with a couple or surrogate
Undergoing the screening process (psychological and medical testing)
Working on contracts
Trying to become pregnant
Pregnant
Not currently involved

* How is/was/will your surrogacy arrangement handled?
By an agency
By some other 3rd party facilitator (doctor, lawyer, etc)
Independently
Undecided

What was your relationship with your couple or surrogate prior to the surrogacy?
Family Member
Friend
Acquaintaince
Did not know eachother before the surrogacy arrangement

Are/Were you pleased with your surrogacy experience, on a whole?
Yes No

Would/Will you do it again? Is there anything that you would have done differently or will do differently the next time?

* Please briefly describe what has led you to pursue surrogacy.

* Which list would you like to join?

* There are 2 subscription options for this listserv. Which would you prefer?

Standard subscription - Messages go out to you as soon as our server receives them. You will usually receive several emails throughout the day,

Digest subscription - You will receive one daily email containing all of the posts from the past 24 hours.

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