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Second Wind Lung Transplant Association


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If you are a transplant recipient, please furnish the following:

If you are currently on the waiting list for a transplant, please furnish the following:

Fees for individuals who join in the Class 1 may be waived or reduced based upon individual circumstances. If you are requesting either a waiver or reduction of the membership fee, you will still need to submit this form so that we can enter your information into our data base. A member of the board will contact you by phone to discuss your request.

Second Wind maintains an on-line Member Directory of Lung Transplant recipients and candidates which is available on our web site to all members in a password protected area. The Directory Includes Membership information of members who have agreed to have their information included. It is intended to be used for information and support purposes only. You will be able to access this area if your dues are current. Participating in the on-line Member Directory is voluntary. Also, Second Wind publishes a newsletter, AirWays, which includes members names from time to time.

Check below if you do not want your membership information made available in the on-line member directory or in the Airways publication unless written permission is provided.