Membership Form

Thank you for your interest in becoming a member of Talk About Sleep; it says you care about sleep. The more people that join, the stronger our collective voice becomes!

Membership is free and benefits include: Monthly Email Newsletters, news alerts, special event invitations, special offers, contests, and new product information.

1. You are a: (check all that apply):

	Sleep disorder patient		Physician
	Respiratory Therapist		Polysomnographic Sleep Technologist
	Member of the commercial sleep community		Sleep related medical professional
	Durable medical equipment supplier (DME)		A person who has an interest in healthy sleep
	Other:

2. Your diagnosed sleep disorder(s) are: (check all that apply)

	Sleep apnea		Narcolepsy
	Insomnia		Restless Legs Syndrome
	Periodic Limb Movement Syndrome		Parasomnias (sleep walking, sleep talking, sleep eating)
	Fibromyalgia		Other:

3. Regardless of whether you are diagnosed or not, what sleep topics are you interested in? (check all that apply)

	Sleep apnea		Narcolepsy
	Insomnia		Restless Legs Syndrome
	Periodic Limb Movement Syndrome		Parasomnias (sleep walking, sleep talking, sleep eating)
	Children’s sleep and sleep disorder issues		Getting better quality sleep for myself and my family
	Fibromyalgia		Other:

4. My gender is: Male Female

5. I was born in the year:

6. I live in the following country:

7. If you live in the United States, what state do you live in?

8. What is your email address? (required in order to receive our monthly newsletter):
We take your privacy very seriously. Your email address will never be used or sold to a third party.
Read our privacy policy for details.

Talk About Sleep, Inc.
14480 Ewing Ave So. Suite 102
Burnsville, MN 55306
Telephone (952) 358-7070
Fax (952) 358-7077