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Egg Donor Application Form Summit Your ApplicationFull fill the form below to get our contact and bonus!Call To Action Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastBirth Date (MM/DD) Birth Date (YYYY)Email *Telephone NumberPlace of BirthAre you a United States citizen or permanent resident?YesNoAre you adopted?NoYesEthniciityHeight (cm / feet, inches)Weight (Kg/Pounds)ABO Blood Types ABABOUnknownA B AB O Unknown Rh TypesPositiveNegativeUnknownPositive Negative Unknown Gender at BirthFemaleMaleFemale MaleCurrent Gender FemaleMaleOtherFemale Male OtherStreet AddressCityStateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYASDSGUMPPRUSAL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS (American Samoa) DC (District of Columbia) GU (Guam) MP (Northern Mariana Islands) PR (Puerto Rico) VI (U.S. Virgin Islands) Zip CodeCountry: United StateYesNoOther CountryAMH Level (ng/ml normal 2~5)Eye ColorBrownBlueBlackGreenHazelGrayAmberBrown Blue Black Green Hazel Gray Amber OtherHair ColorBrownBlackWhiteBlondeRedGrayAuburnOtherBlack Brown White Blonde Red Gray Auburn OtherWhat is your relationship status?SpouseFriendSingleOtherWho do you live with? Spouse Friend Single Other Do you drink?YesNoOccasionallyDo you smoke? YesNoOccasionallyWhat is your highest level of education?What is your current occupation?Have you donated your eggs previously?YesNoIf yes, how many cycles?Have you ever been told you are infertile?NoYesIs there any history of infertility in your family?NoYesAre there any known genetic diseases or conditions that run in your family?Have you tested positive for chlamydia or gonorrhea in the past year?NoYesHave you ever used or injected any recreational drugs or illegal drugs? (Cocaine, marijuana, LSD, heroin, barbiturates, narcotics, opiates, amphetamines, hallucinations, tranquilizers, PCP, steroids, or others.)NoYesIf yes, which drugs, and when were they last used?Are you currently taking any medications?NoYesIf yes, please provide the name and indication.Have you ever been seen by a psychologist, psychiatrist, social worker, counselor, or any other medical health professional for any reason?NoYesIf yes, for how long and what reason?Have you had a tattoo or piercing in which sterile instruments were not used?NoYesDo you accept travel/or taking airplane to have Egg Pick-up domestically?YesNoUnknownDo you accept travel/ or taking airplane to have Egg Pick-up internationally? YesNoUnknownDescribe your favorite hobbies and interests:Describe your personality and characteristics :Upload your unedited photo (max 2 files) Click or drag a file to this area to upload. You can upload your unedited photos with .png, .gif, .jpg, .jpeg. Upload your file. (max 1 files) Click or drag a file to this area to upload. You can upload your fires.. .page, .doc , .pdfSubmit Egg Recipient Registration Form Summit Your RegistrationFull fill the form below to get our contact!.Call To Action Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastBirth Date (MM) Birth Date (YYYY)19?? ~20??Email *Telephone NumberPlace of BirthAre you a United States citizen or permanent resident?YesNoIf not, what is your nationality?EthniciityHeight (cm / feet, inches)Weight (Kg/Pounds)What is your current Gender?FemaleMaleOtherFemale Male Other ABO Blood TypesABABO不知A B AB O 不知 Rh TypesPositiveNegativeUnknownPositive Negative Unknown Street AddressCityStateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWYASDCGUMPPRVIAL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS (American Samoa) DC (District of Columbia) GU (Guam) MP (Northern Mariana Islands) PR (Puerto Rico) VI (U.S. Virgin Islands)Zip CodeCountry: United StateYesNotOther CountryEye Color棕色藍色黑色綠色淡褐色灰色琥珀色其它Brown Blue Black Green Hazel Gray Amber OtherHair Color棕色黑色白色金色紅色灰色赤褐色OtherBlack Brown White Blonde Red Gray Auburn OtheWhat is your relationship status?SpouseFriendSIngleOtherWho do you live with? Spouse Friend Single OtherAre you willing to accommodate the schedule of a fresh egg donor?YesNoUnknownAre you open to receiving frozen eggs?YesNoUnknownWill you require the egg donor to undergo genetic screening for hereditary diseases?YesNoUnknownDo you have any other specific traits or conditions you require from the egg donor?Do you drink?YesNoOccasionallyYes No OccasionallyDo you smoke?YesNoOccasionallyYes No OccasionallyWhat is your highest level of education?What is your current occupation?Had you ever had Surgery?YesNoIf yes, what surgery you had before?Do you have adenomyosis, myoma, or endometriosis now?YesNoHad you have operation of cervical ionization or history of cervical incompetency ? NoYesHad you history of getting cancer?Do you need surrogacy?NoYesDo you have DM, hypertension, autoimmune disease or other Internal medicine diseases? NoYesIf yes, what Internal medicine diseases you have?Have you ever used or injected any recreational drugs or illegal drugs? (Cocaine, marijuana, LSD, heroin, barbiturates, narcotics, opiates, amphetamines, hallucinations, tranquilizers, PCP, steroids, or others.)NoYesIf yes, which drugs, and when were they last used?Are you currently taking any medications?NoYesIf yes, please provide the name and indication.Have you ever been seen by a psychologist, psychiatrist, social worker, counselor, or any other medical health professional for any reason?NoYesIf yes, for how long and what reason?Submit Professional Application Form Summit Your ApplicationFull fill the form below to get our contact to activate your professional membership!Click here to change this text. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis pulvinar dapibus.Call To Action Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Telephone NumberYour Professional PositionPhysician/ProfessorPresident/Director/SupervisorManager/CoordinatorEmbryologist/TechnicianNP/Nurse/NavigatorOther staffPositive Negative Unknown Name of Your OrganizationStreet AddressCityStateALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYASDSGUMPPRUSAL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS (American Samoa) DC (District of Columbia) GU (Guam) MP (Northern Mariana Islands) PR (Puerto Rico) VI (U.S. Virgin Islands) Zip CodeCountry: United StateYesNoOther CountrySubmit Other Language Forms Membership Level change You have selected the Egg Donor membership level. Welcome to GEA Alliance! Your contribution helps make the world more hopeful and beautiful. You have the option to donate your eggs for cryopreservation without a specific recipient, or you can choose to be matched with a designated oocyte recipient for IVF, directly assisting someone in need. The price for membership is $0.00 now. Account Information Already have an account? Log in here Username Password Confirm Password Email Address Confirm Email Address Full Name LEAVE THIS BLANK Payment Information We accept all major credit cards Card Number Expiration Date CVC Processing...