By selecting Apply for Membership below, I confirm that I am an individual with a congential bleeding disorder or a parent of a person with a bleeding disorder. I certify that the information included on this application is true and correct. I authorize this release of information to the Hemophilia Foundation of Maryland in order to verify all statements made in this application. I also give permission to contact a representative at my local hemophilia treatment center or hemotologist office as necessary to confirm diagnosis.