Last modified: 11 May 2000
Team OK consists of functioning heart, liver, lung, kidney, pancreas and bone marrow transplant recipients and volunteers without regard to race, age or abilities.
If you are interested in joining the team and you have a functioning transplant as stated above, please send your information to:
TEAM OKLAHOMA
1514 S. 137th E. Ave.
Tulsa, OK 74108
Name_______________________________________________________________
Address_____________________________________________________________
City______________________State_______________Zip_____________________
Home phone (____)____________________
Work phone (____)____________________ (optional)
Fax (____)____________________
Age________ M_____ F_____
Date of Birth _____/_____/_____ Date of Transplant (TX) _____/_____/_____
Place of TX_______________________________________
Name of TX physician_______________________________
Name of Primary Care Physician_________________________________
Name of Spouse______________________________
Sports of interest _________________________________________________________________________________
_______________________________________________________________________________________________
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