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EGG DONOR QUALIFICATIONS CHECKLIST

You must answer the following questions to see if you qualify for the application process.

* = Required

* Date of birth:
* Are you a non-smoker who leads a healthy lifestyle?	Yes No
* Are you ovulating normally and otherwise exhibiting normal reproductive function?	Yes No
* Are you a heavy drinker or user of recreational drugs?	Yes No
* Is your weight appropriate to your height?	Yes No
NOTE: If you were adopted and wish to be considered as an egg donor, you must have knowledge of your biological parents.