If you do not have a state pro-life medical organization, but you would like to be involved and to be updated regarding national and international life issues, we invite you to join and stand with us for human life from conception (fertilization) through natural death.

Physicians For Life Membership Application Form

(please print)

Name …………...……………………….                           Date…………………………..

Please Circle Preferred Contact Address:

Home ………………………………….. Office …………………………………………….

City, State ……………………………    City, State …………………………………….……   

Zip ……………………………………   Zip…………………………….…………………..

Please Circle Preferred Telephone/ Cell Phone:   

Home (       )………………………..            Office (        )…………………………………

Please print your Email Address: …………………………………………………………   
NOTE: Email will be sent to you only for important messages. It will not be given or sold to any group or individual.

Medical Specialty: ……………………………………………

Hospital(s) ………………………………………………….

Annual TAX-DEDUCTIBLE  Membership Donation
*Practicing Physician         $200.00        Retired Physician     $ 50.00

Resident/Fellow                $25.00        Medical Student  $15.00

*May be paid quarterly or semi-annually, if you wish.

Please make your membership donation check (which is tax-deductible [APFLI is an IRS 501 (c) (3) organization]) payable to our sponsor organization, Alabama Physicians For Life, Inc., and send to APFLI, P.O. Box 2478, Cullman AL 35056-2478. 

You will receive a packet of information, including a certificate, our quarterly newsletter, an electroplated Precious Feet lapel pin, brochures, and other materials within 6 weeks of receipt of your membership donation.

Your membership begins the month your payment is dated/received.


Thank you for standing with us…for their Lives!