Lincoln Ostomy Association Membership Update

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Welcome to another year with Lincoln Ostomy Association! Please complete this form so we can update our contact information for group members.

It’s also time to collect yearly dues and contributions. Any amount is appreciated and goes directly toward educational materials, chapter operations and supplies, and UOAA national dues. Your membership also supports LOA quarterly meetings, the Sparrow newsletter, networking with other ostomates and professionals, and opportunities to share ostomy education in our community.

If you are not able to pay dues, this does not preclude you from LOA benefits. We ask that you still return this form to update your contact information.

First Name *

Last Name *

Birthdate

Please include the day and month of your birthday so we can send you a card! (Also, include your spouse’s name, if applicable, and their day and month of birth.)

Spouse's Name and Birthdate (optional)

Type of Ostomy (check all that apply)

Colostomy

Ileostomy

Urostomy

Double Ostomate

Mailing Address *

City *

State *

Zip Code *

Phone

Email *

Your contact information will be used to send meeting reminders, notes from meetings, and other information related specifically to Lincoln Ostomy Association only.

I give my permission to share my contact information with other LOA members. *

Yes

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