It’s great to be alive—And to help others !

To contact us:

Membership application

Paul Catalano                                The Mended Hearts, Inc.

Phone: 949-770-0387                     c/o Lee Goode

                                                   27211-B Capote de Paseo

E-mail: mdhrts.cox.net                    San Juan Capistrano, CA 92675

The Mended Hearts, Inc., Chapter 216

 

Mended Hearts, a national nonprofit organization affiliated with the American Heart Association, has been offering the gift of hope to heart disease patients, their families and caregivers for more than 50 years. Recognized for its role in facilitating a positive patient-care experience, Mended Hearts partners with 460 hospitals and

rehabilitation clinics and offers services to heart patients through visiting programs, support group meetings and educational forums. Our mission is to “inspire hope in heart disease patients and their families.”

 

PLEASE  PRINT                                                                          Date______________

 

Mr. Mrs. Ms. Name__________________________________

            

             Spouse________________________ Spouse’s Birthday________________

 

Address____________________________________________________________

 

City__________________________ State_________ Zip_________

 

E-mail_____________________ Home phone_____________________

 

Birthday________________________ Episode/Surgery date___________________

(*Dates only used in the Ticker Talker)

Physician/Surgeon_____________________________________________________

 

Type of procedure: PCI__ MI__ BYPASS__ANEURSM__ HEART VALVE(S)___

 

TRANSPLANT______ PACEMAKER/ICD____ ATRIAL SEPTAL DEFECT_____

 

I wish to volunteer to assist the Chapter in these areas: Visiting Patients____

Telephoning ____General____ Driving others to meetings____

Hobbies & Interests__________________________________________________                                                                              

                                                                                           Individual         Family

Initial, Annual, National & Chapter Dues                        $25.                 $32

Life membership, National & Chapter                             $225                $335

Membership fees include both local chapter and National dues.

Annual billings will be from the National office in Dallas, TX

 

___Having experienced heart trauma or surgery, I wish to apply as an active member.

___As an interested person, I wish to apply as an associate member.

___I wish to donate to defray Special Projects and Newsletter Expense  $______

 

Return completed application with check to:

Mended Hearts, Inc Chapter 216,

c/o Mission Hospital, Cardiac Rehab (Helen),

26732 Crown Valley Parkway, Suite 281,

Mission Viejo, CA 92691 (phone 949-364-7755)

T I C K E R   T A L K E R