Seattle Endo Group Contact Us Form
Thank you for contacting the Endometriosis Research Center of Greater Seattle! We are glad you found us and look forward to meeting you!

Please contact us by completing the form below. We do not share your contact information, it is used solely by our board to stay in touch with you and inform you of upcoming educational events!

The Endometriosis Research Center (ERC), also known as the ERC of Greater Seattle, is registered with Washington State’s Charities Program as required by law. ERC Registration #39094. Additional information is available by calling 800-332-4483 or visiting www.sos.wa.gov/charities.

First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
This is how we communicate with all members of our group. Membership is free:). Please check your junk mailbox just in case.
Your answer
How did you find us? *
i.e.: friend, internet search, MD office....
Your answer
How can we support you? *
Please tell us a little about yourself and your current struggles and successes in managing your endometriosis.
Your answer
How would you like to help other women with endo? *
ie: participate in community outreach, physician outreach, fundraising or monetary support, lead local support groups, communication within the group....
Your answer
Supporting the Endometriosis Research Center of Greater Seattle
Please donate below if you would like to support our outreach efforts to women with endo. Our group is 100% volunteer led and donations help support costs associated with our website, providing informational outreach publications, and organizing and hosting events and quality speakers. All donors will receive a receipt via email. Thank you!

The Endometriosis Research Center (ERC), also known as the ERC of Greater Seattle, is registered with Washington State’s Charities Program as required by law. ERC Registration #39094. Additional information is available by calling 800-332-4483 or visiting www.sos.wa.gov/charities.

I would like to donate to the ERC of Greater Seattle~
Donate via Check, Credit Card, or Paypal. Thank you!
Donation Options
Personal Check:
Check:
You may print this form and mail with your check to the ERC of Greater Seattle.

ERC of Greater Seattle
c/o Howard
10624 Alton Place NE
Seattle, WA 98125

Credit Card:
Card Number
Your answer
Exact Name on Card
Your answer
Security Code
Visa and M/C: 3-digit code on the back; Am Ex: 4-digit code on the front
Your answer
Expiration Date
Your answer
Exact Billing Address Including Zip Code
(If different from above)
Your answer
Thank You for Contacting the Seattle Endo Group!
We are looking forward to meeting you!

We are 100% volunteer led and managed. We will respond to your inquiry within the next 7-10 business days, if not sooner.

Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service