American Foundation of Thyroid Patients

Education and Empowerment for Persons with Thyroid Disease  

Membership Application

Please choose one of the annual membership options below:


______  Patient Member -      $20.00                                               

______  Physician Member -  $30.00                                               


________Additional tax-deductible donation                                                          


Name ________________________________________________________________


Address ______________________________________________________________


City, State, Zip _________________________________________________________


Phone (home) ______  __________________________________________________


           (work) ______  ___________________________________________________


Email ________________________________________________________________


Sharing Network

”The Sharing Network”© is a great way to make a difference in another thyroid patient’s life as well as your own. Members of the Foundation are encouraged to join this program for mutual one-on-one exchange.  Please consider joining today!


“My years as a medical practitioner, as well as my own first-hand experience, have taught me how important self-help groups are assisting their members in dealing with problems, stress, hardship and pain…Today, the benefits of mutual aid are experienced by millions of people who turn to others with a similar problem to attempt to deal with their isolation, powerlessness, alienation, and the awful feeling that nobody understands.” --C. Everett Koop, M.D. (1992)


Check here if you wish to join the Sharing Network and indicate your diagnosis:

□ Hypothyroid   □ Hyperthyroid   □ Graves’ Disease  □ Hashimoto’s Thyroiditis  □ Thyroid Cancer   □ Thyroid Eye Disease   □other (_________________)


Today’s Date:__________________________________________________


Signature: _____________________________________________________

           Your contact information will ONLY be shared with other AFTP patient members.



American Foundation of Thyroid Patients

P. O. Box 572472

Houston, TX 77257