Submit Your Preemie Support Group Today!

Are you the leader of or belong to a preemie support group that you believe would benefit other families of premature infants? Would you like that group listed in PreemieCare's Support Group Listing? If so, please complete and submit the form below.


PreemieCare Support Sign-up Form

Group Name:

  required

Group Contact Person:

  required

Group E-mail:

  required

Group Phone:

   

Group Address: 


City:  State:  Zip:

Group Website:

 

Group Setting:

Hospital Based   Community Based required

Group Type:

  required
   ** see below for definitions

Year Established:

        

  # of Members: 

Paid Membership:

yes   no    If yes, yearly dues: $

Non-profit Status:

yes   no not yet application pending
If Yes, what year:

Group Activities:

Check all that apply

Support Meetings    Online Support Meetings     Playgroups
Professional Education   Presentations/Speakers    Fundraisers
Holiday Parties      Other Events(Reunions)       Other

If other, please describe:   


List any  resources provided by the group to:

Non-members:

New members:

Current members:

Does the group  have an e-newsletter

yes   no  
How can PreemieCare sign up to receive a copy?

Does the group have an online forum, email group, chat feature, or other form of online communication for members?

yes   no  
Please describe:

Tell us about your organizational plans for the future:

 

PreemieCare Support Group Listing

 Yes, we want our support group listed on the PreemieCare State-by-State/National Support Group Listing

If logo is to be included, provide a link & description of logo:

Provide a short description/mission statement to use on the listing:
 required for listings

Our group is already listed on PreemieCare’s State list
We do not wish to add our group listing at this time

Support Group Leader Discussion Forum

 Yes, I personally want participate on the PreemieCare’s Support Group Leader Discussion Forum

Your name:      required for participants

Your position:   required for participants

Email to use on forum:   required for participants

Preferred username/login:    required for participants

I already participate on PreemieCare’s Discussion Forum
I do not wish to participate at this time

    


**Group Definitions:

  • NICU Support Group - Support group for parents with babies currently in the NICU.
  • Post-NICU Support Group -Support group for parents post NICU.
  • NICU & Post-NICU Support -Support group for parents with children in or out of the NICU.
  • Preemie Playgroup - Playgroup for parents and their preemies.
  • Bereavement Support Group -Support group for a lost pregnancy or death of a child.
  • Other:  Please explain.


PreemieCare
P.O. Box 306
(631) 859-1110
East Islip, NY 11730
info@preemiecare.org