Apply to Agency: Int'l Assisted Reproduction Center

Int'l Assisted Reproduction Center

You must answer all questions. In addition, this agency requires you to meet these criteria:

All of your pregnancies have been full-term (past 37 weeks gestation) and resulted in vaginal deliveries
You are willing to carry a twin pregnancy
You did not experience any major complications during your pregnancies or deliveries such as hemorrhaging or bed rest
You are not currently receiving any welfare payments or public assistance
You are not a smoker
You have not been treated for depression or any mental disorder for a total of 3 years or more
You do not have a criminal record
If applicable, your spouse/significant other is in favor of this procedure
You are a permanent US resident
You are willing to travel, expenses paid, to a non-local clinic for medical procedures
You agree to respond to International Assisted Reproduction Center
All information provided is true to the best of your knowledge
Must be a resident of one of these states: IL, MN

Contact Information
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Phone:
Email:

Best Time to Reach You:
Are You an Experienced Surrogate?:

Tell Us About Yourself
Age:	years
Height:	feet inches
Weight:	pounds

Have all of your pregnancies been full-term (past 37 weeks gestation) and resulted in vaginal deliveries?
Are you willing to carry a twin pregnancy?
Did you experience any major complications during your pregnancies or deliveries such as hemorrhaging or bed rest?
Are you currently receiving any welfare payments or government assistance?
Are you a smoker?
Have you been treated for depression or any mental disorder for a total of 3 years or more?
Do you have a criminal record?
If applicable, is your spouse/significant other in favor of this procedure?
Are you a permanent US resident?
Are you willing to travel, expenses paid, to a non-local clinic for medical procedures?
A representative from International Assisted Reproduction Center will be contacting you. Do you agree to respond to International Assisted Reproduction Center?
All information that you have provided will be verified. Is all information presented above true to the best of your knowledge?

What is your most important question or concern about becoming a surrogate mother?

Learn More About Becoming a Surrogate Mother